Chronic Disease 1 Flashcards
1
Q
Cardiology causes of clubbing?
A
Infective endocarditis
Congenital causes of cyanosis
2
Q
What is malar flush a sign of?
A
Rheumatic mitral stenosis (its commonly in AF)
3
Q
4 things when assessing pulse?
A
Rate
Rhythm
Volume
Character
4
Q
Slow rising pulse indicates?
A
Aortic stenosis
5
Q
Collapsing pulse indicates?
A
Aortic regurgitation
6
Q
Wide pulse pressure indicates?
A
Aortic regurgitation
7
Q
‘Diffuse’ apex beat indicates?
A
Dilated ventricle
8
Q
‘Tapping’ apex beat indicates?
A
Mitral stenosis
9
Q
Mid-systolic clic =?
A
Mitral valve prolapse
10
Q
Opening snap =?
A
Mitral stenosis
11
Q
What size does the abdominal aorta have to be to be considered an aneurysm?
A
> 4cm
12
Q
Hepatomegaly and a pulsatile liver (pulsatile hepatomegaly) can indicate what?
A
Right sided heart failure
13
Q
Where is the mid-inguinal point?
A
Half way between the ASIS and pubic symphysis
14
Q
Where do you find the femoral pulse?
A
Mid-inguinal point
15
Q
What are 4 long term causes of atrial fibrillation?
A
Hypertension
Valvular heart disease
Dilated Cardiomyopathy
Ischaemic heart disease
16
Q
What are 4 acute causes of atrial fibrillation?
A
Pneumonia/acute exacerbation of COPD
PE
Holiday heart syndrome (alcohol)
Thyrotoxicosis
17
Q
Rate control options for AF
A
Beta-blockers
Ca2+ channel blockers
18
Q
Rhythm control options for AF
A
Na+ channel blockers
K+ channel blockers
19
Q
What is Brugada syndrome? ECG changes?
A
Genetic Na+ channelopathy
ECG: ST elevation V1, V2 and t-wave inversion
20
Q
How do you calculate max. HR?
A
220-age
21
Q
What can congenital long QT syndrome lead to?
A
Toursades de pointes
22
Q
What 3 drugs can cause acquired long QT syndrome?
A
Class 3 anti-arrhythmics (e.g. amiodarone)
anti-depressants/antipsychotics
erythromycin
23
Q
Functional flow reserve measures the flow of blood through an atherosclerotic vessel, what value is an indication for stenting?
A
<0.8
24
Q
What does ARVC stand for?
A
Arrhythmogenic Right Ventricular Cardiomyopathy
25
How does ARVC present?
palpitations and blackout
26
Difference between malignant and benign ectopics?
Malignant - worse on exertion
| Benign - disappear with sinus rhythm
27
MOA of Flecanide
Na+ channel blocker
28
CONTRAINDICATION for flecanide use?
Coronary artery disease
29
What should pts on long term flecanide use receive every 2 years?
Treadmill test
30
What are the symptoms of bradycardia?
Dizziness, blackouts, tiredness
31
2 causes of symptomatic bradycardia?
- Complete heart block
| - Problem with the SA node
32
4 causes of low-voltage r-waves on an ECG?
- dilated cardiomyopathy
- pericardial effusion
- obesity
- poor skin preparation
33
What murmur does aortic stenosis cause?
Ejection systolic
34
What murmur does Mitral regurgitation cause?
Pan-systolic
35
What murmur does aortic regurgitation cause?
Early diastolic
36
What murmur does mitral stenosis cause?
Diastolic murmur (rumbling)
37
Left sided murmurs are heard loudest on...
Expiration
38
Right sided murmurs are heard loudest on...
Inspiration
39
Why can VERY SEVERE murmurs disappear?
Stroke vol. becomes very low, so no turbulent blood flow, so no murmur
40
2 potential side effects of amiodarone?
- photosensitivity (slate grey appearance if exposed to UV light)
- Altered thyroid function (contains iodine)
41
Type of anticoagulation used for mechanical heart valves?
Warfarin
42
What degree of aortic stenosis is required to cause symptoms?
1.5cm2
43
What is sever stenosis (in AS) and indicated surgery?
Stenosis <1cm2
44
How long do biological valves last?
10-15yrs
45
Why is warfarin not good for older its with hypertension?
Increased risk of cerebral haemorrhage
46
What does TAVI stand for?
Trans Aortic Valve Implantation
47
4 causes of ST-elevation
- Infarction
- Ventricular aneurysm
- Electrolyte imbalance
- Pericarditis
48
Cotrimoxasole = combo of what 2 drugs?
Trimethoprim + Sulfamexosole
49
Which patients is cotrimoxasole indicate in?
HIV with PCP
50
4 drugs for secondary prevention post MI?
- 2x anti platelet (clopidogrel (1yr), aspirin (lifelong))
- anti-hypertensive (e.g. ramipril)
- beta-blocker
- statin
51
What should you give during an acute MI?
- 300mg aspirin
- 300mg clopidogrel
- Morphine
- GTN
- Metoclopramide/cyclizine
- LMWH
52
What electrolyte imbalance can ACEi (e.g. ramipril) cause?
Hyperkalaemia
53
Potential side effect of Ca2+ channel blocker?
Peripheral oedema
54
On an ECG, if V1 is predominantly -ve, this indicates...
Left bundle branch block
55
On an ECG, if V1 is predominantly +ve, this indicates...
Right bundle branch block
56
What is Ivabridine?
Similar to a beta-blocker, often better tolerated
57
Syndrome X?
cardiac chest pain with no coronary artery disease
58
Symptoms of aortic stenosis
- chest pain
- breathlessness
- syncope
59
How would you treat a blocked LAD?
Coronary bypass surgery (not stenting)
60
Difference between CRP and ESR?
```
CRP = acute inflammatory marker
ESR = long term inflammatory marker
```
61
Pt presents with painless loss of vision in 1 eye...
Giant cell arteritis (temporal arteritis)
62
Treatment of giant cell arteritis (temporal arteritis)?
High does steroids
63
Vasculitis = autoimmune condition causing inflammation of the vessels, what would you find on bloods?
ANCA +ve
64
Symptoms of HF?
- swelling
- breathlessness (on exertion, orthopnoea)
- Cough (productive - pink, frothy)
65
Signs of HF?
- oedema
- S4 gallop beat
- Raised JVP
- Hepatomegaly / hepatosplenomegaly
66
HF with preserved ejection fraction indicates...
diastolic HF
67
Blood test for HF?
BNP
68
5 causes of HF?
- Coronary artery disease (decreased perfusion, so heart dies)
- Valvular disease
- Structural heart disease
- Hypertension
- Anaemia
69
Drugs for treatment of HF?
- ACEi
- Beta-blocker
- Spironolactone (aldosterone antagonist)
- Furosemide (symptom control)
70
How much do you expect Hb to go up for every unit of blood given?
10
71
Pre-renal causes of AKI
- NSAID
- ACEi
- Dehydration
72
Chronic kidney disease = >3months of...
- Haematuria
- Proteinurea
- Impaired kidney function
73
Diarrhoea in bouts and early in the morning is suggestive of...
IBS
74
Change of bowel habits that wakes pt in the night suggests...
IBD
75
4 extra intestinal signs of IBD...
- arthralgia
- erythema nodosum
- p. gangrenous
- episcleritis
76
what is erythema nodosum?
non-tender patchy red rash on shins
77
what is p. gangrenosum?
painful ulcerations on shins
78
presentation of episcleritis?
red, itchy eye
| watery/blurry vision
79
Upper GI bleed can cause an increase in XXX on bloods
urea
80
Symptoms of IBD
- abdo pain
- diarrhoea
- weight loss
- urgency (UC)
81
UC is associated with what biliary problem?
Primary sclerosis cholangitis
82
What is the difference between a type 1 and type 2 MI?
- type 1 = problem with the heart
| - type 2 = due to secondary cause
83
3 potential causes of a secondary MI?
- Sepsis
- Anaemia
- Thyrotoxicosis
84
What is a normal PR interval?
3-5 small squares (120-200ms)
85
Normal QT interval?
up to 10 small squares
86
How does ARVC present on ECG?
t-wave inversion
87
narrow QRS indicates?
atrial ectopic beats
88
broad QRS indicates?
Ventricular ectopic beats
89
What must be present on an ECG for it to be L or R BBB?
broad QRS complex
90
Anabolic steroids can do what to the heart?
dilation of the heart
91
What does ALD stand for?
Adrenoleukodystrophy
92
What is ALD?
genetic disease mostly affecting men/boys, where the myelin sheath gets destroyed
93
Symptoms of ALD?
- childhood regression
- blindness
- deafness
- seizures
- loss of muscle control
- progressive dementia
94
A patient with a fistula (for dialysis) presents with a painful/paralysed/cold distal limb...
= ischaemia due to STEAL
| fistula needs to be 'tied off'
95
Genetic pattern of polycystic kidney disease?
Autosomal dominant
96
Symptoms/signs of polycystic kidney disease
- loin pain
- visible haematuria
- cyst infection
- hypertension
- renal calculi
- progressive renal failure
97
5 Extra-renal manifestations of polycystic kidney disease
- liver cysts
- intracranial aneurysm
- mitral valve prolapse
- ovarian cyst
- diverticular disease
98
Bumetanide?
Like furosemide, but for gut oedema
99
signs of nephrotic syndrome?
- peripheral oedema
- hypoalbuminaemia
- protien in urine
100
What is minimal change disease an example of?
Nephrotic syndrome
101
How would you treat minimal change disease?
steroids
102
SEs of steroids?
- weight gain
- mood disturbances
- DM
- immunosuppression
- thin skin
- ulcers
103
What eGFR value would indicate the need for dialysis?
<8
104
what does obesity do to the kidneys?
causes scarring
105
V. large polycystic kidney pressing on IVC can cause...
dizziness
106
V. large polycystic kidney splinting the diaphragm can cause...
difficulty breathing
107
cyst in brain causing haemorrhage linked with polycystic kidney disease, known as
beri aneurysm
108
Why does nephrotic syndrome cause high cholesterol?
body increases production of albumin and cholesterol is a by-product
109
2 SEs of statins
- muscle cramps
| - deranged LFTs
110
Why can pts with CKD be anaemic?
kidneys are responsible for the production of erythropoietin
111
Conn's syndrome
hyperaldosteronism
112
Cushing's
high cortisol
113
pheochromocytoma
adrenaline secreting tumour
114
Respiratory causes of chronic breathlessness
- COPD
- Infection
- interstitial lung disease
- Malignancy
115
Cardiac causes of chronic breathlessness
- Heart failure
- Angina
- Arrhythmias
116
'Other' causes of chronic breathlessness (non cardiac or Resp)
- aneamia
- obesity
- CKD
- drug SEs
117
normal QRS duration
<120ms
118
Inverted p-waves can indicate...
LA enlargement
119
p-wave >2.5small squares high...
p pulmonale (RA enlargement)
120
For every 2l of ascites that you drain off, give...
1 unit of 'salt-poor albumin'
121
symptoms of myeloma
- bone pain
- pathological fractures
- fatigue
- sob
- nausea
- weight loss
- recurrent infection
- increased thirst/urination
122
3 causes of a failed short synacthen test:
- Addison's disease (autoimmune)
- Pituitary problem
- Pt on high dose steroids for a long time (secondary hypoadrenalism)
123
3 investigations for adrenal adenoma
- 24urine catecholamines
- short synacthen test
- dexamathasone suppression test
124
symptoms of pituitary adenoma (and therefore low hormone lvls)
- joint pain
- nerve pain
- muscle cramps
- dizziness
- fatigue
- shaking
- polydypsia
- polyuria
125
acute adrenal insufficiency gives...
lack of cortisol
126
symptoms of lack of acute adrenal insufficiency
- fatigue
- weight loss
- dizziness
- low BP
- abdo pain
- nausea + vomiting
- hyperpigmentation
127
lab findings of: hyponatraemia, hyperkalaemia, normochromic anaemia, hypoglycaemia and pre-renal failure indicate...
acute adrenal insufficiency
128
management of acute adrenal insufficiency
Hydrocortisone (+rehydration)
129
Acute hypercalcaemia symptoms:
Bones, stones, moans and groans
- polyuria +thirst
- anorexia, nausea, consitpation
- muscle weakness
- mood disturbances
130
5 causes of hypercalcaemia
- primary hyperparathyroidism
- malignancy
- familial hypocalciuric hypercalcaemia
- phaeochromocytoma
- immobilisation
131
ECG changes in hypercalcaemia
shortened QT interval
132
Management of acute hypercalcaemia (3)
- fluids
- bisphosphonates
- parathyroidectomy (rare)
133
symptoms of acute hypocalcaemia
- muscle twitch/spasm
- +ve trousseau and chrostek's sign
- peri-orbital + digital paraesthesia
134
causes of acute hypocalcaemia
- thyroidectomy
- Vit. D deficiency
- cytotoxic drug induced
- pancreatitis
- rhabdomyelitis
135
management of acute hypocalcaemia
- oral calcium
| - vit D (if needed)
136
severe hypocalcaemia = medical emergency, treatment is...
calcium gluconate
137
patient presents with vomiting, seizures, confusion and headaches - symptoms of...
severe hyponatraemia
138
treatment of severe hyponatraemia
hypertonic saline
139
What does hypoadrenalism do to BP
DECREASES it
140
Fludrocortisone is a replacement for what?
aldosterone
141
Is fludrocortisone given in cases of secondary hypoadrenalism?
no, as the RAAS system is still functioning
142
hydrocortisone + prednisolone replace...
cortisol
143
4 Symptoms of Addison's
- weight loss
- fatigue
- postural hypotension
- hyperpigmentation
144
Treatment of addisons
steroids + fluids
145
Addison's: main blood test finding
hyponatraemia
146
What is the short synacthen test?
Give synthetic ACTH, measure cortisol lvls 30mins later
147
exudate fluid is rich in...
protein
| malignant, infective and inflammatory causes
148
transudate fluid is low in...
protein
| caused by increased portal pressure, e.g. heart/liver failure
149
What are the findings of a +ve lymph node biopsy in pt with suspected sarcoidosis
non-casiating granulomas
150
high free T4 + T3, low TSH
PRIMARY HYPERTHYROIDISM
151
3 causes of primary hyperthyroidism
- Grave's disease
- Solitary toxic adenoma
- Toxic multi nodular goitre
152
iodine therapy can be used to treat...
primary hyperthyroidism
153
drug given to treat hyperthyroidism (mainly Graves)
carbimazole
154
Risks of long term carbimazole use:
- agranulocytosis
| - liver dysfunction
155
proctitis = ?
swollen eyes, seen in thyroid disease
156
Levothyroxine = synthetic...
T4
157
Trachea shifted AWAY
pleural effusion
158
Trachea shifted TOWARDS
collapsed lung
159
Glargine = ...
long acting insulin (given at bed time)
160
fast acting insulin give at every meal...
novorapid
161
hypoglycaemia = blood sugar
<4.0mmol/l
162
4 hormones that increase blood sugars
- glucagon
- adrenaline
- cortisol
- noradrenaline
163
Dopamine agonists can be used to treat..
microprolactinoma
164
treatment of infective exacerbation of COPD
- antibiotics
- nebulised salbutamol and ipratropium
- oral steroids
165
what patients cannot have a beta blocker
pts with asthma
166
Pleuritic chest pain worse on inspiration is suggestive of...
PE
167
Swollen calf, hypoxic, achy, clear chest, hypotensive...
PE
168
Tachy, hypotensive, sweaty, pale clammy, HF signs...
MI
169
pyrexia, bronchial breathing, coarse crackles
Pneumonia
170
what score do you use for PEs
WELLS score
171
what drug can be used for the reversal of warfarin
vitamin K
172
tachypnoeic, use of accessory muscles, wheeze....
asthma
173
peak flow >50%
mild asthma
174
peak flow <50%
severe asthma
175
peak flow <35%
life threatening
176
ABG finding in life-threatening asthma
normal or high CO2 (pt no longer blowing off CO2)
177
tracheal deviation (away), hyper-resonance, reduced breath sounds over one area...
pneumothorax
178
management of acute exacerbation of asthma:
- nebuliser
- steroids (e.g. prednisolone)
- IV magnesium (bronchodilator)
- IV aminophyline (ITU referral)
179
Site of needle thoracocentesis for pneumothorax
2nd intercostal space, mid-clavicular line
180
primary pneumothorax = pneumothorax in pts with...
no underlying lung disease - requires aspiration
181
secondary pneumothorax = pneumothorax in pts with...
underlying lung disease - requires chest drain
182
pneumothorax >Xcm requires intervention
>2cm
183
What is the triple therapy for COPD inhalers?
LABA, LAMA, ICS
184
What type of respiratory failure do you see with idiopathic pulmonary fibrosis?
type 1
185
end inspiratory fine crackles, clubbing, cachectic, frail are signs of...
idiopathic pulmonary fibrosis
186
honeycomb lung on chest CT...
idiopathic pulmonary fibrosis
187
treatment of nasal polyps
topical steroids
188
drug that can be used for persistent asthma cough
azithromycin
189
What needs to be checked in pts on azithromycin
LFTs + ECG (QTc)
190
'ground glass shadowing' on CT indicates...
lung inflammation
191
the formation of what is seen in sarcoidosis
granulomas
192
What ion is a marker or sarcoidosis activity?
Ca2+
193
azathioprine = ...
immunosuppressant
194
Symptoms of pulmonary hypertension
- pulmonary hypertension
- breathlessness
- chest pain
- syncope
195
signs of pulmonary hypertentsion
- RV heave
- pansystolic murmur
- raised JVP
196
what scoring system is used in pneumonia?
CURB-65
197
CURB-65 score >2
IV abx + admission
198
CURB-65 score <2
oral abx + home
199
stratification score for risk of PE
WELLS score
200
WELLS score <1
D-dimer
201
WELLS score >1
CTPA
202
Cystic fibrosis = due to mutation in which gene?
CFTR
203
treatment of CF
- chest physio
- mucolytics
- bronchodilators
- nutritional supplements
204
Tear at the junction between the oesophagus and stomach =
mallory-weirs tear
205
2 acute causes of encephalopathy
- paracetamol overdose
| - hepatitis
206
5 causes of chronic encephalopathy
- hepatitis
- CF
- alcohol
- non-alcoholic fatty liver disease
- cancer
207
Definition of encephalopathy
disruption of normal brain signalling due to a build up of toxins
208
Allopurinol MOA
increases uric acid excretion from the kidneys
209
indication for allopurinol
>2 episodes of gout in 1 year
210
where is gout most commonly seen
big toe
211
how often should lithium levels be checked
3months
212
drug that can suppress extra-pyramidal SEs in PD
procyclidine
213
Toxic effects of lithium
- coma
| - AV node heart block
