Corrections 1 Flashcards
Why is a rhythm control approach ofter preferred for AF in younger patients?
This eliminates the need to take medications long term.
Interaction between macrolides & statins?
Particularly with simvastatin.
Clarithromycin inhibits the P450 system, which results in increased levels of simvastatin in the body.
This increases the risk of statin related side effects such as myalgia, myopathy and rhabdomyolysis (elevated CK levels).
When is new onset considered for electrical cardioversion?
If presents <48 hours
What valvular defect does a mid-diastolic murmur heard best in expiration indicate?
Mitral stenosis
How are mitral stenosis patients who are asymptomatic generally monitored?
Monitor with regular echos
Next step for woman <30 presenting with an unexplained breast lump?
Non-urgent referral
For patients with breast cancer presenting with clinically palpable lymphadenopathy, how can this be confirmed?
With US guided biopsy
For patients with breast cancer presenting with clinically palpable lymphadenopathy (which is confirmed with an US guided biopsy), what indicated?
Axillary node clearance is indicated at primary surgery
When is surgical excision for a breast fibroadenoma indicated?
If >3cm
What is tamoxifen?
A SERM (selective oestrogen receptor modulator).
It acts as an oestrogen receptor antagonist and partial agonist.
Indication for tamoxifen?
Management of oestrogen receptor-positive breast cancer.
Adverse effects of tamoxifen?
- menstrual disturbance e.g. abnormal bleeding, amenorrhoea
- hot flushes
- VTE
- endometrial cancer
What are aromatase inhibitors?
Anastrozole & letrozole - these reduce peripherla oestrogen synthesis.
Indication for aromatase inhibitors e.g. anastrozole?
ER+ve breast cancer in post-menopausal women
What drug is indicated for neuropathic pain (both peripheral and central)?
Pregabalin, amitriptyline & gabapentin.
What are 2 good choices of antiemetics in Parkinsons?
Cyclizine & domperidone
1st line for spasmodic pain in palliative care?
Diazepam
What type of respiratory failure can MND cause?
Type 2 (due to muscle weaknes, leading to a buildup of CO2)
An air embolus is a rare but severe complication of central line insertion (where a large air embolus enters the venous circulation).
How may patients present?
Sudden circulatory collapse immediately after insertion.
What are 2 methods of reducing the risk of an air embolus during central line insertion?
1) Trendelenburg position: patient lies with their head tilted down 15 degrees and feet elevated in air
2) Flush line whilst advancing it to aid distension
how does the Trendelenburg position reduce risk of air embolus in central line insertion?
This allows gravity to assist the filling and distension of the upper central veins to reduce the risk of air entering the system.
Which bacteria is the most common cause of endocarditis in patients following prosthetic valve surgery (i.e. <2 months)?
Coagulase-negative Staphylococci e.g. Staph. epidermis
Which bacteria is the most common cause of endocarditis in patients >2 months following prosthetic valve surgery?
Staph aureus (i.e. same as normal population)
What should be considered in HF if the patient has sinus rhythm >75 bpm and an LVEF <35% and have not responded to ACEi, beta blockers and aldosterone antagonist therapy (e.g. spironolactone)?
Ivabradine
When is digoxin preferred in HF?
if patients have co-existing AF
What murmur can HOCM present with?
Ejection systolic murmur louder on performing a Valsalva and quieter on squatting.
What will an ECG typically show evidence of in HOCM?
LV hypertrophy
What causes an ejection systolic murmur in HOCM?
Subaortic hypertrophy of the ventricular septum, resulting in LV outflow tract obstruction and functional aortic stenosis.
What is management of aortic stenosis based on?
1) If the patient is symptomatic
2) LV systolic function
In asymptomatic patients with aortic stenosis, what is the LVEF cut off for aortic valve replacement?
LVEF <50%
In asymptomatic patients with aortic stenosis, what is the mean aortic valve gradient cut off for aortic valve replacement?
> 40 mmHg
What is the mean aortic valve gradient?
This measures the average pressure difference across the aortic valve during the cardiac cycle.
A gradient of <40 mmHg indicates that the degree of aortic stenosis may be mild or moderate rather than severe.
Which bronchus are inhaled foreign objects most likely found in?
Right main bronchus
Which antiparkinson drug is associated with the greatest improvements in symptoms and ADLs?
Co-careldopa (levodopa + carbidopa)