Common Cardio and Resp diseases Flashcards
Asthma aetiology
Atopy - familial, IgE.
Airway hyper responsiveness and intermittent airway obstruction.
Signs of Asthma
Tachypnoea Audible wheeze Hyper inflated chest Hyper resonant percussion. Decreased air entry - widespread polyphonic wheeze.
Symptoms of Asthma
Intermittent dyspnoea
Wheeze
Cough (nocturnal)
Sputum production
Investigations for Asthma
Peak Expiratory Flow on walk before and after dilators Spirometry Exercise tolerance test FBC Skin prick for allergen
Treatment for Asthma
- Inhaled short acting B2 agonist
- Add standard dose of inhaled corticosteroid
- Add Long acting beta agonist.
- Consider trials of increasing corticosteroid.
What is COPD?
Chronic Obstructive Pulmonary Disease - Bronchitis, Emphysema,.
Causes of COPD
Smoking
Air pollution
Occupational exposure
Signs of COPD
Use of accessory muscles on expiration Decreased chest expansion Coarse crackles Hyper - resonance Clubbing
Symptoms of COPD
Morning cough - then constant.
Productive sputum
SOB
Wheeze
Investigations for COPD
FBC Spirometry Chest X-ray ECG (cor pulmonale) Arterial Blood Gas
Treatment for COPD
Smoking cessation Pulmonary rehabilitation 1. Short-acting beta agonist. Systemic corticosteroid 2. Inhaled corticosteroid 3. Long acting beta agonist or Long acting muscarinic antagonist. Oxygen (long term)
Lung cancer aetiology
Smoking Asbestos Environmental Occupation Air pollution
What are the different types of lung cancer?
Squamous cell carcinoma (40%)
Adenocarcinoma (41%)
Small cell carcinoma (15%)
Large cell carcinoma (4%)
Signs of Lung cancer
Chest signs Finger clubbing Lymphadenopathy Horner's syndrome Hepatomegaly
Symptoms of lung cancer
Cough Haemoptysis Dyspnoea Chest pain Recurrent pneumonia Unexplained weight loss.
Investigations for lung cancer
Chest x-ray FBC LFT Spirometry CT thorax and abdomen
Treatment for Lung cancer
Surgery (lobectomy)
Radiotherapy
Chemotherapy
Immunotherapy
T (tumour) N (nodes) M (metastases) staging used for severity.
Tuberculosis aetiology
Mycobacteria species, mainly:
mycobacterium tuberculosis and mycobacterium bovis.
HIV
TB signs
Lung consolidation
Bronchial breath sounds
Crackles on auscultation
TB symptoms
Presence of risk factors Cough weight loss Fever Night sweats Fatigue and malaise
TB investigations
3 sputum specimens on successive days (smear, culture and PCR) Chest X-ray CT thorax Bronchoscopy Biopsy
TB treatment
Rifampicin Isoniazid Ethambutol Pyrazinamide All for 2 months
Then for 4 months
Rifampicin
Isoniazid
Side effects of TB drugs
Rifampin - Orange urine, tears, inactivation of oral contraceptive.
Isoniazid - Hepatitis and peripheral neuropathy
Ethambutol - Optical neuropathy
Pyrazinamide - Gout
Stable angina aetiology and risk factors
Atherosclerosis
Thrombosis / Blood clot
Risk factors: Obese, history of heart disease, high cholesterol, hypertension,d diabetes.
Signs of stable angina
Xanthalasma and corneal arcus.
Hypertension
Tremor
Tachycardia
Symptoms of stable angina
Central chest tightness - often radiation to neck and arms. Aggravated by exertion and stress. Dyspnoea Dizziness Fatigue Sweating Palpitations Claudication
Investigations for stable angina
Exercise tolerance test
Stress ECHO
Exercise with ECG
Exercise stress test
Treatment for stable angina
Relief by stopping activity/ stress.
Sublingual nitrate spray (GNT spray)
Smoking cessation
Treat risk factors - Hypertension, obesity etc
Hypertension aetiology
Polygenic Age Genetics and Fam history. Environment Weight Alcohol Race - black more at risk.
Signs of Hypertension
Retinopathy
BP over or equal to 140/90
Symptoms of Hypertension
Usually not any
Chest pain
SOB
Investigations for hypertension
BP home monitoring to confirm diagnosis.
ECG
Echocardiogram
Urine analysis
Treatment for Hypertension
Step 1: CCB if over 55 and black. If CCB not suitable then thiazide type diuretic.
Ace inhibitor if <55yrs,
NOT WOMEN OF CHILD BEARING AGE OR BLACK ETHNICITY.
Step 2:
Thiazide-type diuretic added to CCB or Ace inhibitor.
Step 3:
Add ACE inhibitor, CCB and diuretic together.
Step 4:
Resistant hypertension:
low dose spironolactone or higher dose diuretic if K over 4.5mmol/l.
What are the stages of hypertension?
Stage 1: Clinic BP 140/90 or higher.
Stage 2: Clinic BP 160/100mmHg or higher.
Severe: Systolic 180 or higher. Diastolic 110mmHg or higher
Deep Vein Thrombosis aetiology
Many factors: Surgery Lower limb problems Reduced mobility Previous proven venous thromboemboli
DVT signs
Can be clinically silent.
Unilateral pitting oedema.
Unilateral limb swelling.
DVT symptoms
Warmth Erythema (redness) Prominent collateral veins Persisting discomfort Calf tenderness Pigmentation Ulceration (severe)
DVT investigations
Clinical assessment
Pre-test probability score (well’s score)
Blood test ( D dimer has high sensitivity for VTE)
Compression Ultrasound
DVT treatment
Unfractionated heparin Low molecular weight heparin Warfarin Direct oral anticoagulants Thrombylisis (massive DVT)
NSTEMI / STEMI aetiology
Thrombosis
Atherosclerosis
Risk Factors:
Age, gender, family history, smoking, diabetes.
- NSTEMI what is it?
2. STEMI what is it?
- Partial occlusion of coronary artery.
2. Complete obstruction of the coronary artery.
Signs of 1. NSTEMI 2. STEMI 3. BOTH
- Common ST-segment depression and T wave inversion. ELEVATED troponin.
- ST segment elevation in ECG.
- Distress, anxiety, 4th heart sound, pallor, pan systolic murmur, low grade fever.
Symptoms of NSTEMI and STEMI
Extreme fatigue Dyspnoea Dizziness Angina Oedema Abdominal swelling Profuse sweating
NSTEMI and STEMI Investigations
ECG Cardiac biomarkers (troponin) ECHO Elevated serum levels FBC CT angiogram
Treatment for NSTEMI
MONAC: Morphine Oxygen Nitro-glycerine Aspirin Clopidiogrel
ABAS: Aceinhib Beta blockers Aspirin Statins
Treatment for STEMI
Primary coronary artery bypass or thrombolysis. Angiography.
MONAC: Morphine Oxygen Nitro-glycerine Aspirin Clopidogrel
MORE SEVERE
Pneumonia aetiology
Strep pneumonia +ve
Staph aureus +ve
E.coli -ve
Pneumonia signs
Pyrexia Tachnopnoea Central cyanosis Dullness on percussion of affected lobes. Brachial breathing Increase vocal resonance
Pneumonia symptoms
Malaise Myalgia Fever Chest pain (pleuritic) Cough Rusty sputum SOB
Pneumonia investigations
CRP and FBC Chest X-ray Blood cultures Throat swab HIV test
Treatment for pneumonia
CURB65 (confusion, blood, Urea > 7, RR >30, diastolic BP<60 age > 65.
- Amoxycillin, or clarithromycin
- BOTH
- Then add amoxiclav
Oxygen, IV fluids, intubation.