CSW2 clinical cases conundrums Flashcards
What drugs can be used for diabetes?
Metformin
DPP4 inhibitors
Pioglitazone
Sulphonylureas
What should be given to a patient with diabetes who has atherosclerotic cardiovascular disease?
Empagliflozin
Liraglutide
When is a second medicine added for diabetes when someone is already on non insulin therapy? What is added?
If glucose control is not adequate on noninsulin treatment for 3 months and a second oral agent, GLP1 receptor agonist or basal insulin
Why are empaglifozin and liraglutide indicated in some diabetic patients? Include who they are given to
They reduce mortality in those with atherosclerotic cardiovascular disease so should be given to these patients
If you have an arterial problem what is given?
Aspirin
What type of drug is aspirin and how does it work?
It is an antiplatelet that prevents a platelet plug forming
If you have a venous problem what medication is useless?
Aspirin- never give it, turning off platelets is useless
What is arterial vs venous prophylaxis?
Arterial= aspirin Venous= warfarin, apixaban, rivaroxiban
What drug for AF rhythm control will not cause a fall in BP and may be given instead of a beta blocker?
Digoxin
What are the catagories for chadsvasc score
Congestive HF Hypertension Age >75 Age 65-74 Diabetes mellitus Stroke/TIA Vascular disease Female sex
What score does a male v female need on the chadsvasc score to need anticoagulation
Male= 2 Female= 3
How will you explain to a patient with AF what they have and what drugs they need?
Irregular pulse
Dont worry about it- very common
Small risk of stroke due to your score
We think it would be helpful to give you a drug to thin your blood a bit and then give you a beta blocker to control your HR and it will return to normal
What is fast vs slow AF?
Slow= HR under 60
What 2 drugs can someone with AF be given and sent home if they are not very unwell ie the simplest treatment?
Blood thinner eg apixaban
Beta blocker
How is pericarditis managed?
NSAIDs if in pain
Reassurance
Why are antivirals contraindicated in pericarditis?
The virus has come and gone and the inflammation is causing the changes so antivirals are not needed as they wont be effective
Explain william and marrow in rbbb vs lbbb?
RBBB- MarroW
V1= m
V6= w
LBBB- WilliaM
v1= w
v6= m
Which way round is william and marrow in lbbb and rbbb? How do you remember this
rbbb= marrow lbbb= william
w comes after m in the alphabet and less people are left handed
What segment is uninterpretable in someone with lbbb? What effect does this have?
ST
They may have an MI because you dont know if there is actually ST segment elevation
What do you treat a first presentation of lbbb as when there is no previous ecg?
MI
In what type(s) of heart block is syncope seen?
Only third degree (complete heart block)
What is seen on first, second degree mobtiz 1, second degree mobtiz II and third degree heart block on ECG?
First= prolonged PR interval
Second degree mobitz I= prolonged PR interval and then dropped p wave
Second degree mobtiz II= dropped p wave with no prior PR interval elongation
Third degree= no relation between p waves and QRS
What are first, second degree mobtiz 1, second degree mobtiz II and third degree heart block by definition?
First= reduced conduction through AV node
Second degree mobitz I= varying conduction through AV node
Second degree mobtiz II= unexpected non conducted atrial impulse
Third degree= complete lack of conduction through AV node
How are first, second degree mobtiz 1, second degree mobtiz II and third degree heart block managed?
First= no treatment needed, give cardiac monitor
Second degree mobitz I= no treatment, give cardiac monitor, give atropine if bradycardic, revoew medication
Second degree mobtiz II= fit pacemaker and review meds
Third degree= fit pacemaker and review meds
What is seen in the neck in complete heart block?
Cannon wave
What sign is diagnostic of complete heart block?
Cannon wave on neck
In what type(s) of heart block does a pacemaker need to be fitted?
Second degree mobitz II
Third degree
How does a cannon wave arise?
In complete heart block the ventricle wont contract and so the blood comes shooting back into the atria and up into the jugular vein
What is the role of physiotherapists?
Balance Muscle strengthening Practise transfer from bed to chair Practise mobility Build confidence Teach them techniques to get up if there is another fall Help with walking aids Practice with stairs Non drug pain management
What does OT do?
Basic adls
They check if people can wash, dress, shop
Plan environmental adaptations eg handrail fitting, toilet adaptations, chair/stool in shower
Commnication aids erc
How well does consolidation conduct sound? What will happen to tactile vocal fremitus and breath sounds?
Very well, you will hear both loudly
What is bronchial breathing?
Loud breath sounds conducted loudly and rapidly through consolidation
