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3rd Year > Chronic Disease 1 > Flashcards

Chronic Disease 1 Flashcards

1
Q

Cardiology causes of clubbing?

A

Infective endocarditis

Congenital causes of cyanosis

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2
Q

What is malar flush a sign of?

A

Rheumatic mitral stenosis (its commonly in AF)

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3
Q

4 things when assessing pulse?

A

Rate
Rhythm
Volume
Character

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4
Q

Slow rising pulse indicates?

A

Aortic stenosis

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5
Q

Collapsing pulse indicates?

A

Aortic regurgitation

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6
Q

Wide pulse pressure indicates?

A

Aortic regurgitation

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7
Q

‘Diffuse’ apex beat indicates?

A

Dilated ventricle

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8
Q

‘Tapping’ apex beat indicates?

A

Mitral stenosis

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9
Q

Mid-systolic clic =?

A

Mitral valve prolapse

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10
Q

Opening snap =?

A

Mitral stenosis

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11
Q

What size does the abdominal aorta have to be to be considered an aneurysm?

A

> 4cm

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12
Q

Hepatomegaly and a pulsatile liver (pulsatile hepatomegaly) can indicate what?

A

Right sided heart failure

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13
Q

Where is the mid-inguinal point?

A

Half way between the ASIS and pubic symphysis

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14
Q

Where do you find the femoral pulse?

A

Mid-inguinal point

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15
Q

What are 4 long term causes of atrial fibrillation?

A

Hypertension
Valvular heart disease
Dilated Cardiomyopathy
Ischaemic heart disease

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16
Q

What are 4 acute causes of atrial fibrillation?

A

Pneumonia/acute exacerbation of COPD
PE
Holiday heart syndrome (alcohol)
Thyrotoxicosis

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17
Q

Rate control options for AF

A

Beta-blockers

Ca2+ channel blockers

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18
Q

Rhythm control options for AF

A

Na+ channel blockers

K+ channel blockers

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19
Q

What is Brugada syndrome? ECG changes?

A

Genetic Na+ channelopathy

ECG: ST elevation V1, V2 and t-wave inversion

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20
Q

How do you calculate max. HR?

A

220-age

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21
Q

What can congenital long QT syndrome lead to?

A

Toursades de pointes

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22
Q

What 3 drugs can cause acquired long QT syndrome?

A

Class 3 anti-arrhythmics (e.g. amiodarone)
anti-depressants/antipsychotics
erythromycin

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23
Q

Functional flow reserve measures the flow of blood through an atherosclerotic vessel, what value is an indication for stenting?

A

<0.8

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24
Q

What does ARVC stand for?

A

Arrhythmogenic Right Ventricular Cardiomyopathy

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25
Q

How does ARVC present?

A

palpitations and blackout

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26
Q

Difference between malignant and benign ectopics?

A

Malignant - worse on exertion

Benign - disappear with sinus rhythm

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27
Q

MOA of Flecanide

A

Na+ channel blocker

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28
Q

CONTRAINDICATION for flecanide use?

A

Coronary artery disease

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29
Q

What should pts on long term flecanide use receive every 2 years?

A

Treadmill test

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30
Q

What are the symptoms of bradycardia?

A

Dizziness, blackouts, tiredness

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31
Q

2 causes of symptomatic bradycardia?

A
  • Complete heart block

- Problem with the SA node

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32
Q

4 causes of low-voltage r-waves on an ECG?

A
  • dilated cardiomyopathy
  • pericardial effusion
  • obesity
  • poor skin preparation
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33
Q

What murmur does aortic stenosis cause?

A

Ejection systolic

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34
Q

What murmur does Mitral regurgitation cause?

A

Pan-systolic

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35
Q

What murmur does aortic regurgitation cause?

A

Early diastolic

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36
Q

What murmur does mitral stenosis cause?

A

Diastolic murmur (rumbling)

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37
Q

Left sided murmurs are heard loudest on…

A

Expiration

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38
Q

Right sided murmurs are heard loudest on…

A

Inspiration

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39
Q

Why can VERY SEVERE murmurs disappear?

A

Stroke vol. becomes very low, so no turbulent blood flow, so no murmur

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40
Q

2 potential side effects of amiodarone?

A
  • photosensitivity (slate grey appearance if exposed to UV light)
  • Altered thyroid function (contains iodine)
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41
Q

Type of anticoagulation used for mechanical heart valves?

A

Warfarin

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42
Q

What degree of aortic stenosis is required to cause symptoms?

A

1.5cm2

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43
Q

What is sever stenosis (in AS) and indicated surgery?

A

Stenosis <1cm2

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44
Q

How long do biological valves last?

A

10-15yrs

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45
Q

Why is warfarin not good for older its with hypertension?

A

Increased risk of cerebral haemorrhage

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46
Q

What does TAVI stand for?

A

Trans Aortic Valve Implantation

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47
Q

4 causes of ST-elevation

A
  • Infarction
  • Ventricular aneurysm
  • Electrolyte imbalance
  • Pericarditis
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48
Q

Cotrimoxasole = combo of what 2 drugs?

A

Trimethoprim + Sulfamexosole

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49
Q

Which patients is cotrimoxasole indicate in?

A

HIV with PCP

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50
Q

4 drugs for secondary prevention post MI?

A
  • 2x anti platelet (clopidogrel (1yr), aspirin (lifelong))
  • anti-hypertensive (e.g. ramipril)
  • beta-blocker
  • statin
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51
Q

What should you give during an acute MI?

A
  • 300mg aspirin
  • 300mg clopidogrel
  • Morphine
  • GTN
  • Metoclopramide/cyclizine
  • LMWH
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52
Q

What electrolyte imbalance can ACEi (e.g. ramipril) cause?

A

Hyperkalaemia

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53
Q

Potential side effect of Ca2+ channel blocker?

A

Peripheral oedema

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54
Q

On an ECG, if V1 is predominantly -ve, this indicates…

A

Left bundle branch block

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55
Q

On an ECG, if V1 is predominantly +ve, this indicates…

A

Right bundle branch block

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56
Q

What is Ivabridine?

A

Similar to a beta-blocker, often better tolerated

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57
Q

Syndrome X?

A

cardiac chest pain with no coronary artery disease

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58
Q

Symptoms of aortic stenosis

A
  • chest pain
  • breathlessness
  • syncope
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59
Q

How would you treat a blocked LAD?

A

Coronary bypass surgery (not stenting)

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60
Q

Difference between CRP and ESR?

A 
CRP = acute inflammatory marker
ESR = long term inflammatory marker
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61
Q

Pt presents with painless loss of vision in 1 eye…

A

Giant cell arteritis (temporal arteritis)

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62
Q

Treatment of giant cell arteritis (temporal arteritis)?

A

High does steroids

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63
Q

Vasculitis = autoimmune condition causing inflammation of the vessels, what would you find on bloods?

A

ANCA +ve

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64
Q

Symptoms of HF?

A
  • swelling
  • breathlessness (on exertion, orthopnoea)
  • Cough (productive - pink, frothy)
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65
Q

Signs of HF?

A
  • oedema
  • S4 gallop beat
  • Raised JVP
  • Hepatomegaly / hepatosplenomegaly
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66
Q

HF with preserved ejection fraction indicates…

A

diastolic HF

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67
Q

Blood test for HF?

A

BNP

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68
Q

5 causes of HF?

A
  • Coronary artery disease (decreased perfusion, so heart dies)
  • Valvular disease
  • Structural heart disease
  • Hypertension
  • Anaemia
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69
Q

Drugs for treatment of HF?

A
  • ACEi
  • Beta-blocker
  • Spironolactone (aldosterone antagonist)
  • Furosemide (symptom control)
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70
Q

How much do you expect Hb to go up for every unit of blood given?

A

10

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71
Q

Pre-renal causes of AKI

A
  • NSAID
  • ACEi
  • Dehydration
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72
Q

Chronic kidney disease = >3months of…

A
  • Haematuria
  • Proteinurea
  • Impaired kidney function
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73
Q

Diarrhoea in bouts and early in the morning is suggestive of…

A

IBS

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74
Q

Change of bowel habits that wakes pt in the night suggests…

A

IBD

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75
Q

4 extra intestinal signs of IBD…

A
  • arthralgia
  • erythema nodosum
  • p. gangrenous
  • episcleritis
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76
Q

what is erythema nodosum?

A

non-tender patchy red rash on shins

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77
Q

what is p. gangrenosum?

A

painful ulcerations on shins

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78
Q

presentation of episcleritis?

A

red, itchy eye

watery/blurry vision

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79
Q

Upper GI bleed can cause an increase in XXX on bloods

A

urea

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80
Q

Symptoms of IBD

A
  • abdo pain
  • diarrhoea
  • weight loss
  • urgency (UC)
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81
Q

UC is associated with what biliary problem?

A

Primary sclerosis cholangitis

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82
Q

What is the difference between a type 1 and type 2 MI?

A
  • type 1 = problem with the heart

- type 2 = due to secondary cause

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83
Q

3 potential causes of a secondary MI?

A
  • Sepsis
  • Anaemia
  • Thyrotoxicosis
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84
Q

What is a normal PR interval?

A

3-5 small squares (120-200ms)

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85
Q

Normal QT interval?

A

up to 10 small squares

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86
Q

How does ARVC present on ECG?

A

t-wave inversion

87
Q

narrow QRS indicates?

A

atrial ectopic beats

88
Q

broad QRS indicates?

A

Ventricular ectopic beats

89
Q

What must be present on an ECG for it to be L or R BBB?

A

broad QRS complex

90
Q

Anabolic steroids can do what to the heart?

A

dilation of the heart

91
Q

What does ALD stand for?

A

Adrenoleukodystrophy

92
Q

What is ALD?

A

genetic disease mostly affecting men/boys, where the myelin sheath gets destroyed

93
Q

Symptoms of ALD?

A
  • childhood regression
  • blindness
  • deafness
  • seizures
  • loss of muscle control
  • progressive dementia
94
Q

A patient with a fistula (for dialysis) presents with a painful/paralysed/cold distal limb…

A

= ischaemia due to STEAL

fistula needs to be ‘tied off’

95
Q

Genetic pattern of polycystic kidney disease?

A

Autosomal dominant

96
Q

Symptoms/signs of polycystic kidney disease

A
  • loin pain
  • visible haematuria
  • cyst infection
  • hypertension
  • renal calculi
  • progressive renal failure
97
Q

5 Extra-renal manifestations of polycystic kidney disease

A
  • liver cysts
  • intracranial aneurysm
  • mitral valve prolapse
  • ovarian cyst
  • diverticular disease
98
Q

Bumetanide?

A

Like furosemide, but for gut oedema

99
Q

signs of nephrotic syndrome?

A
  • peripheral oedema
  • hypoalbuminaemia
  • protien in urine
100
Q

What is minimal change disease an example of?

A

Nephrotic syndrome

101
Q

How would you treat minimal change disease?

A

steroids

102
Q

SEs of steroids?

A
  • weight gain
  • mood disturbances
  • DM
  • immunosuppression
  • thin skin
  • ulcers
103
Q

What eGFR value would indicate the need for dialysis?

A

<8

104
Q

what does obesity do to the kidneys?

A

causes scarring

105
Q

V. large polycystic kidney pressing on IVC can cause…

A

dizziness

106
Q

V. large polycystic kidney splinting the diaphragm can cause…

A

difficulty breathing

107
Q

cyst in brain causing haemorrhage linked with polycystic kidney disease, known as

A

beri aneurysm

108
Q

Why does nephrotic syndrome cause high cholesterol?

A

body increases production of albumin and cholesterol is a by-product

109
Q

2 SEs of statins

A
  • muscle cramps

- deranged LFTs

110
Q

Why can pts with CKD be anaemic?

A

kidneys are responsible for the production of erythropoietin

111
Q

Conn’s syndrome

A

hyperaldosteronism

112
Q

Cushing’s

A

high cortisol

113
Q

pheochromocytoma

A

adrenaline secreting tumour

114
Q

Respiratory causes of chronic breathlessness

A
  • COPD
  • Infection
  • interstitial lung disease
  • Malignancy
115
Q

Cardiac causes of chronic breathlessness

A
  • Heart failure
  • Angina
  • Arrhythmias
116
Q

‘Other’ causes of chronic breathlessness (non cardiac or Resp)

A
  • aneamia
  • obesity
  • CKD
  • drug SEs
117
Q

normal QRS duration

A

<120ms

118
Q

Inverted p-waves can indicate…

A

LA enlargement

119
Q

p-wave >2.5small squares high…

A

p pulmonale (RA enlargement)

120
Q

For every 2l of ascites that you drain off, give…

A

1 unit of ‘salt-poor albumin’

121
Q

symptoms of myeloma

A
  • bone pain
  • pathological fractures
  • fatigue
  • sob
  • nausea
  • weight loss
  • recurrent infection
  • increased thirst/urination
122
Q

3 causes of a failed short synacthen test:

A
  • Addison’s disease (autoimmune)
  • Pituitary problem
  • Pt on high dose steroids for a long time (secondary hypoadrenalism)
123
Q

3 investigations for adrenal adenoma

A
  • 24urine catecholamines
  • short synacthen test
  • dexamathasone suppression test
124
Q

symptoms of pituitary adenoma (and therefore low hormone lvls)

A
  • joint pain
  • nerve pain
  • muscle cramps
  • dizziness
  • fatigue
  • shaking
  • polydypsia
  • polyuria
125
Q

acute adrenal insufficiency gives…

A

lack of cortisol

126
Q

symptoms of lack of acute adrenal insufficiency

A
  • fatigue
  • weight loss
  • dizziness
  • low BP
  • abdo pain
  • nausea + vomiting
  • hyperpigmentation
127
Q

lab findings of: hyponatraemia, hyperkalaemia, normochromic anaemia, hypoglycaemia and pre-renal failure indicate…

A

acute adrenal insufficiency

128
Q

management of acute adrenal insufficiency

A

Hydrocortisone (+rehydration)

129
Q

Acute hypercalcaemia symptoms:

A

Bones, stones, moans and groans

  • polyuria +thirst
  • anorexia, nausea, consitpation
  • muscle weakness
  • mood disturbances
130
Q

5 causes of hypercalcaemia

A
  • primary hyperparathyroidism
  • malignancy
  • familial hypocalciuric hypercalcaemia
  • phaeochromocytoma
  • immobilisation
131
Q

ECG changes in hypercalcaemia

A

shortened QT interval

132
Q

Management of acute hypercalcaemia (3)

A
  • fluids
  • bisphosphonates
  • parathyroidectomy (rare)
133
Q

symptoms of acute hypocalcaemia

A
  • muscle twitch/spasm
  • +ve trousseau and chrostek’s sign
  • peri-orbital + digital paraesthesia
134
Q

causes of acute hypocalcaemia

A
  • thyroidectomy
  • Vit. D deficiency
  • cytotoxic drug induced
  • pancreatitis
  • rhabdomyelitis
135
Q

management of acute hypocalcaemia

A
  • oral calcium

- vit D (if needed)

136
Q

severe hypocalcaemia = medical emergency, treatment is…

A

calcium gluconate

137
Q

patient presents with vomiting, seizures, confusion and headaches - symptoms of…

A

severe hyponatraemia

138
Q

treatment of severe hyponatraemia

A

hypertonic saline

139
Q

What does hypoadrenalism do to BP

A

DECREASES it

140
Q

Fludrocortisone is a replacement for what?

A

aldosterone

141
Q

Is fludrocortisone given in cases of secondary hypoadrenalism?

A

no, as the RAAS system is still functioning

142
Q

hydrocortisone + prednisolone replace…

A

cortisol

143
Q

4 Symptoms of Addison’s

A
  • weight loss
  • fatigue
  • postural hypotension
  • hyperpigmentation
144
Q

Treatment of addisons

A

steroids + fluids

145
Q

Addison’s: main blood test finding

A

hyponatraemia

146
Q

What is the short synacthen test?

A

Give synthetic ACTH, measure cortisol lvls 30mins later

147
Q

exudate fluid is rich in…

A

protein

malignant, infective and inflammatory causes

148
Q

transudate fluid is low in…

A

protein

caused by increased portal pressure, e.g. heart/liver failure

149
Q

What are the findings of a +ve lymph node biopsy in pt with suspected sarcoidosis

A

non-casiating granulomas

150
Q

high free T4 + T3, low TSH

A

PRIMARY HYPERTHYROIDISM

151
Q

3 causes of primary hyperthyroidism

A
  • Grave’s disease
  • Solitary toxic adenoma
  • Toxic multi nodular goitre
152
Q

iodine therapy can be used to treat…

A

primary hyperthyroidism

153
Q

drug given to treat hyperthyroidism (mainly Graves)

A

carbimazole

154
Q

Risks of long term carbimazole use:

A
  • agranulocytosis

- liver dysfunction

155
Q

proctitis = ?

A

swollen eyes, seen in thyroid disease

156
Q

Levothyroxine = synthetic…

A

T4

157
Q

Trachea shifted AWAY

A

pleural effusion

158
Q

Trachea shifted TOWARDS

A

collapsed lung

159
Q

Glargine = …

A

long acting insulin (given at bed time)

160
Q

fast acting insulin give at every meal…

A

novorapid

161
Q

hypoglycaemia = blood sugar

A

<4.0mmol/l

162
Q

4 hormones that increase blood sugars

A
  • glucagon
  • adrenaline
  • cortisol
  • noradrenaline
163
Q

Dopamine agonists can be used to treat..

A

microprolactinoma

164
Q

treatment of infective exacerbation of COPD

A
  • antibiotics
  • nebulised salbutamol and ipratropium
  • oral steroids
165
Q

what patients cannot have a beta blocker

A

pts with asthma

166
Q

Pleuritic chest pain worse on inspiration is suggestive of…

A

PE

167
Q

Swollen calf, hypoxic, achy, clear chest, hypotensive…

A

PE

168
Q

Tachy, hypotensive, sweaty, pale clammy, HF signs…

A

MI

169
Q

pyrexia, bronchial breathing, coarse crackles

A

Pneumonia

170
Q

what score do you use for PEs

A

WELLS score

171
Q

what drug can be used for the reversal of warfarin

A

vitamin K

172
Q

tachypnoeic, use of accessory muscles, wheeze….

A

asthma

173
Q

peak flow >50%

A

mild asthma

174
Q

peak flow <50%

A

severe asthma

175
Q

peak flow <35%

A

life threatening

176
Q

ABG finding in life-threatening asthma

A

normal or high CO2 (pt no longer blowing off CO2)

177
Q

tracheal deviation (away), hyper-resonance, reduced breath sounds over one area…

A

pneumothorax

178
Q

management of acute exacerbation of asthma:

A
  • nebuliser
  • steroids (e.g. prednisolone)
  • IV magnesium (bronchodilator)
  • IV aminophyline (ITU referral)
179
Q

Site of needle thoracocentesis for pneumothorax

A

2nd intercostal space, mid-clavicular line

180
Q

primary pneumothorax = pneumothorax in pts with…

A

no underlying lung disease - requires aspiration

181
Q

secondary pneumothorax = pneumothorax in pts with…

A

underlying lung disease - requires chest drain

182
Q

pneumothorax >Xcm requires intervention

A

> 2cm

183
Q

What is the triple therapy for COPD inhalers?

A

LABA, LAMA, ICS

184
Q

What type of respiratory failure do you see with idiopathic pulmonary fibrosis?

A

type 1

185
Q

end inspiratory fine crackles, clubbing, cachectic, frail are signs of…

A

idiopathic pulmonary fibrosis

186
Q

honeycomb lung on chest CT…

A

idiopathic pulmonary fibrosis

187
Q

treatment of nasal polyps

A

topical steroids

188
Q

drug that can be used for persistent asthma cough

A

azithromycin

189
Q

What needs to be checked in pts on azithromycin

A

LFTs + ECG (QTc)

190
Q

‘ground glass shadowing’ on CT indicates…

A

lung inflammation

191
Q

the formation of what is seen in sarcoidosis

A

granulomas

192
Q

What ion is a marker or sarcoidosis activity?

A

Ca2+

193
Q

azathioprine = …

A

immunosuppressant

194
Q

Symptoms of pulmonary hypertension

A
  • pulmonary hypertension
  • breathlessness
  • chest pain
  • syncope
195
Q

signs of pulmonary hypertentsion

A
  • RV heave
  • pansystolic murmur
  • raised JVP
196
Q

what scoring system is used in pneumonia?

A

CURB-65

197
Q

CURB-65 score >2

A

IV abx + admission

198
Q

CURB-65 score <2

A

oral abx + home

199
Q

stratification score for risk of PE

A

WELLS score

200
Q

WELLS score <1

A

D-dimer

201
Q

WELLS score >1

A

CTPA

202
Q

Cystic fibrosis = due to mutation in which gene?

A

CFTR

203
Q

treatment of CF

A
  • chest physio
  • mucolytics
  • bronchodilators
  • nutritional supplements
204
Q

Tear at the junction between the oesophagus and stomach =

A

mallory-weirs tear

205
Q

2 acute causes of encephalopathy

A
  • paracetamol overdose

- hepatitis

206
Q

5 causes of chronic encephalopathy

A
  • hepatitis
  • CF
  • alcohol
  • non-alcoholic fatty liver disease
  • cancer
207
Q

Definition of encephalopathy

A

disruption of normal brain signalling due to a build up of toxins

208
Q

Allopurinol MOA

A

increases uric acid excretion from the kidneys

209
Q

indication for allopurinol

A

> 2 episodes of gout in 1 year

210
Q

where is gout most commonly seen

A

big toe

211
Q

how often should lithium levels be checked

A

3months

212
Q

drug that can suppress extra-pyramidal SEs in PD

A

procyclidine

213
Q

Toxic effects of lithium

A
  • coma

- AV node heart block

3rd Year (2 decks)

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