DPD Flashcards
(107 cards)
1
Q
What are the risk factors for ischaemic heart disease?
A
smoking
diabetes mellitus
hypertension
hyperlipidaemia
previous episode of IHD
FHx of IHD
2
Q
Differentials for chest pain
A
cardiac: IHD/ACS, aortic dissection, pericarditis
resp: PE, pneumonia, pneumothorax
GI: oesophageal spasm, oesophagitis, gastritis
Musculoskeletal: costochondritis
3
Q
Risk factors for PE
A
clots in legs (DVT), previous PE, recent fracture, malignancy, recent surgery, recent immobility, oral contraceptive pill
long haul flight (immobility)
4
Q
ECG pattern for left ventricular hypertrophy
A
deep S in V1/V2
tall R wave in V5/V6
largest S and largest R in chest leads > 45mm when added together
5
Q
ECG features of ischaemia
A
ST change (elevation or depression)
T wave inversion (MI)
pathological Q waves (old MI)
6
Q
Which leads on an ECG represent a lateral view of the heart?
A
I, aVL, V5, V6
7
Q
what coronary artery supplies the lateral territory of the heart?
A
circumflex artery
8
Q
what ECG leads present the anterior aspect of the heart?
A
V3, V4 and V2 to some extent
9
Q
what coronary artery supplies the anterior territory of the heart?
A
LAD
10
Q
what coronary artery supplies areas of the heart matching to V3, V4 and V2 (to an extent)?
A
Left anterior descending
11
Q
what coronary artery supplies areas of the heart matching to I, aVL, V5 and V6?
A
circumflex artery
12
Q
what ECG leads represent the septal region of the heart?
A
V1 and V2
13
Q
What coronary artery supplies the septal region of the heart?
A
left anterior descending
14
Q
what coronary artery supplies the region corresponding to V1 and V2 on ECG?
A
left anterior descending
15
Q
what ECG leads correspond to the inferior aspect of the heart?
A
II, III and aVF
16
Q
what coronary artery supplies the inferior region of the heart?
A
right coronary artery
17
Q
what coronary artery supplies the area of the heart corresponding to II, III and AvF?
A
right coronary artery
18
Q
differentials for collapse
A
hypoglycaemia
cardiac: postural hypotension,
arrhythmias, outflow obstruction [HOCM, severe AS, massive PE], vasovagal syncope
seizure
19
Q
what does a long QT on ECG mean?
A
abnormal ventricular repolarisation which predisposes patients to ventricular tachycardias
20
Q
differentials for a raised JVP
A
right heart failure - secondary to LHF or pulmonary HTN
tricuspid regurgitation
constrictive pericarditis (infection, CTD, malignancy)
21
Q
what causes a systolic murmur?
A
aortic stenosis
mitral regurgitation
tricuspid regurgitation
ventricular septal defect
22
Q
Causes of sinus tachycardia
A
sepsis
hypovolaemia
thyrotoxicosis
phaeochromocytoma
anxiety
23
Q
causes of atrial fibrillation
A
thyrotoxicosis
ischaemic damage to heart muscle
chest infection
alcohol
pathology affecting the heart or lungs
24
Q
causes of ventricular tachycardia
A
ischaemia electrolyte abnormality (K+, Mg+) long QT
25
Robert attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 125/85 mmHg.
How would you manage this patient?
he is HAEMODYNAMICALLY STABLE
1. Vagal manoeuvres (e.g. carotid sinus massage)
2. Adenosine (IV) x 3
3. if unable to return to sinus may DC cardiovert
adenosine is CI in asthmatics
26
what are the 2 common types of supra-ventricular tachycardia?
AV nodal reentrant tachycardia [AVNRT]
atrioventricular reciprocating tachycardia [AVRT} - accessory pathway present
27
Alex attends A&E with palpitations. His ECG shows an supra-ventricular tachycardia. His BP is 80/60mmHg.
How would you manage this patient?
he is haemodynamically unstable
the arrhythmia is compromising his CO.
DC cardioverstion
28
Jo attends GP for a health check. The GP feels her pulse and finds it to be irregularly irregular. An ECG confirms AF.
How would you manage Jo?
as don't know onset....
Rhythm control:
anti-coagulate for 3-4 weeks if suitable candidate for cardioversion. use NOAC or warfarin
Rate control: beta blocker, digoxin
prophylaxis: CHADs VASC vs HASBLED. anti-coagulate with NOAC or warfarin e.g. riveroxaban
investigate possible underlying causes and treat
29
Lucy attends A&E with palpitations. Her ECG shows a ventricular tachycardia. She has a palpable radial pulse. her BP is 120/80mmHg
as she is haemodynamically stable do not shock immediately
1. IV amiodarone
if pulseless VT -\> start ALS and cardioversion as soon as possible
30
what is S3 associated with?
rapid ventricular filling
31
what is S4 associated with?
ventricular hypertrophy and the atria trying to contract against the stiff ventricle
32
Max is a 65yr old man who attends A&E with an acute deterioration of his heart failure.
How do you manage him in A&E?
1. sit him up
2. oxygen if saturations are low
3. GTN infusion (venodilates reducing preload)
4. diaMorphine (venodilates)
5. Furosemide IV - diuretic and venodilates
treat any underlying cause e.g. infection
33
What are ECG features of pericarditis?
saddle-shaped ST elevation across all leads or most of them (not belonging to a specific heart territory)
34
differentials of pleuritic chest pain
5 Ps
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology
sub-diaphragmatic pathology may cause it too e.g. hepatic abscess
35
Max has been admitted after an acute episode of heart failure. How will you manage his heart failure in the long term?
1. ACEi -\> prevent cardiac remodelling
2. beta-blocker - reduce work
3. spironolactone - prevents chronic RAAS activity
4. diuretic (furosemide)
5. digoxin
ABDDS
36
differentials for breathlessness
seconds: pneumothorax, PE, foreign body
mins/hours: airway inflammation/obstruction, chest infection, acute heart failure
days/weeks: interstitial lung disease, malignancy, large pleural effusion, neuromuscular, anaemia, thyrotoxicosis, any of the above as chronic process
37
what is the management of a PE?
give LMWH
start warfarin
continue LMWH until INR within therapeutic levels.
38
If the FEV1/FVC ratio is \> 70% what sort of lung disease might a patient have?
restrictive
39
If the FEV1/FVC ratio is \< 70% what sort of lung disease might a patient have?
obstructive
40
what might cause interstitial/alveolar shadowing on a CXR ?
fluid - pulmonary oedema
pus - pneumonia
blood - pulmonary haemorrhage
41
what can cause reticulo-nodular shadowing on a CXR?
lung fibrosis
42
what can cause a homogenous shadow on a CXR?
pleural effusion
lung or lobar collapse
43
what are the signs of chronic liver disease?
ABCDEFGHIJ+S
asterixis
bruising
clubbing
dupuytren's contracture
palmar erythema
fetor hepaticus
gynaecomastia
hair loss
icterus/jaundice
spider naevi
leukonychia (due to hypoalbuminaemia)
44
causes of hepatomegaly
3 C's and 1 I
cancer - primary or mets
cirrhosis - early on
cardiac - CCF, constrictive pericarditis
Infiltrative: fatty infiltrate, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases
45
causes of jaundice
AADVM
alcohol
autoimmune
drugs
viral
biliary disease
46
causes of splenomegaly
HI HI
H- portal HTN
Haematological - lymphoproliferative diseases, myeloproliferative diseases or haemolytic anaemia
Infection: TB, brucellosis
infiltration: chronic inflammatory conditions (sarcoidosis)
47
differentials of epigastric pain:
stomach - peptic ulcer, GORD, gastritis, malignancy
acute pancreatitis
MI
ruptured aortic aneurysm
cholecystitis
hepatitis
48
differentials for RUQ pain
cholecystitis, cholangitis, gallstones (biliary colic)
hepatitis, abscess
basal pneumonia
appendicitis (retro-caecal or pregnancy more likely)
peptic ulcer
pancreatitis
pyelonephritis
49
differentials for right iliac fossa pain
appendicitis
mesenteric adenitis
colitis (IBD)
malignancy
ovarian cyst rupture
ovarian cyst twist
ovarian cyst bleed
Ectopic Pregnancy
50
differentials of suprapubic pain
cystitis
urinary retention
51
differentials for left iliac fossa pain
diverticulitis
colitis (IBD)
malignancy
ovarian cysts rupture/twist/bleed
Ectopic Pregnancy
52
diffuse abdominal pain
Bowel obstruction
peritonitis
gastroenteritis
IBD
mesenteric ischaemia
DKA, Addison's, hypercalcaemia
porphyria, lead poisoning
53
causes of an ascitic transudate?
low protein level
cirrhosis
cardiac failure
54
causes of an ascitic exudate
high protein level
malignancy in the abdomen, pelvis or peritoneum
infection = TB, pyogenic (cause formation of pus)
nephrotic syndrome (this is only because overall albumin is low)
budd-chiari syndrome
portal vein thrombosis
55
What does the celiac artery supply?
stomach
spleen
liver
gallbladder
part of the duodenum
56
what does the superior mesenteric artery supply?
small intestine
right colon
57
what does the inferior mesenteric artery supply?
left colon
rectum is supplied by a branch of the iliac artery
58
differentials for abdomial distention
THE 5 F'S
fluid (ascites)
flatus
fat
faeces
foetus
59
causes of bloody diarrhoea
infective colitis (campylobacter, E.coli, entaemoeba histolytica, salmonella, shigella)
inflammatory colitis (young)
ischaemic colitis (older)
diverticulitis
malignancy
60
What might cause a pre-hepatic jaundice?
```
increased haemolysis (e.g. haemolytic anaemia)
Gilbert's syndrome (reduced glucuronidation)
```
61
what might cause a hepatic jaundice?
hepatitis (autoimmune, alcohol, drugs, viruses)
62
what might cause a post-hepatic jaundice?
gallstones in the common bile duct
stricture
cancer of pancreas head
63
What does thumb-printing on an AXR suggest?
mucosal oedema
64
What does featureless colon on an AXR suggest?
IBD
65
What medications should be given to patients presenting with variceal bleeding due to portal HTN?
terlipressin - induces splanchnic vasoconstriction reducing pressure in the portal system
Antibiotics -\> taxosin
66
How would you manage a patient with an acute abdomen?
INVESTIGATIONS
bloods: FBC, U&Es, LFTs, CRP, G&S, clotting, x-match
erect CXR
may need CT
MANAGEMENT PLAN
1. monitor vitals and urine output
2. NBM and fluids
3. analgesia
4. anti-emetics
5. Abx - cephalosporins, metronidazole
67
how would you manage a patient with ascites?
diuretics (spironolactone +/- furosemide)
dietary sodium restrictioni
fluid restrict if hyponatraemic
monitor weight daily
therapeutic paracentesis (drainage) with IV human albumin
68
How would you manage a patient present with hepatic encephalopathy?
lactulose (reduce gut transit time)
phosphate enemas
avoid sedation
treat any infection and exclude a GI bleed
69
what is the presenting complaint for an anal fissure/
severe pain on defecating
stool coated with small amount of bright red blood
70
What would you tell a patient with anal fissure and what might you prescribe?
increase fibre and fluid in their diet
GTN cream to vasodilate vessels improving blood flow to promote healing
71
what are signs of an UMN lesion?
increase tone (spasticity)
reduced power
hyperreflexia
upgoing plantar reflex
72
what are the signs of a LMN lesion?
reduced tone (flaccid)
reduced power
hyporeflexia
73
What are signs of cerebellar pathology?
DANISH
Dysdiadochokinesia (tested with rapid alternating movements)
Ataxia
Nystagmus
Intention tremor
Speech - slurred, scanning
Hypotonia
74
How would you manage a stroke?
\< 4.5 hours - CT if no haemorrhage THROMBOLYSIS
\> 4.5hrs - CT head to exclude haemorrhage, aspirin, swallow assessment, maintain hydration + oxygenation + monitor glucose
75
How would you manage a TIA?
aspirin
ECG, echocardiogram
Carotid doppler
Risk factor modification
76
Lucy attends A&E finding it hard to breath. her lips are swollen and she has a diffuse rash. Her friend says she had just eaten a snack and then suddenly couldn't breathe.
How would you manage lucy?
ANAPHYLAXIS
1. IM adrenaline 1mg
2. 10mg chlorphenamine (anti-histamine)
3. 100mg hydrocortisone
77
What are organisms that cause an atypical pneumonia?
mycoplasma pneumoniae
chlamydia pnuemoniae
legionella pneumoniae
78
What antibiotic is given to patients diagnosed with a hospital acquired pneumonia?
tazosin
79
How would you further investigate a microcytic anaemia?
haematinics (iron studies, B12 and folate)
coeliac screen - TTG antibodies
80
what results of blood tests would you expect a patient suffering from DIC to have?
low platelets
low fibrinogen
high PT and APTT
high D-dimer and fibrin degradation products
81
what are hereditary causes of haemolytic anaemia?
hereditary spherocytosis
hereditary elliptocytosis
G6PD deficiency, pyruvate kinase deficiency
sickle cell disease, thalassaemia
82
what are acquired causes of a haemolytic anaemia?
autoimmune (SLE)
some drugs
infection
MAHA
83
what are the complications of diabetes?
microvascular = retinopathy, neuropathy, nephropathy
macrovascular = MI, stroke, PVD
metabolic = DKA, HHS, hypoglycaemia
84
What would be the differential for a patient present with backache with hypercalcaemia, low PT and normal ALP ?
multiple myeloma
85
What features do patients with multiple myeloma have?
CRAB
Calcium is high
Renal impairment
Anaemia
Bone (pain/ache or fracture)
86
What might cause a cavitating lung lesion?
infection = Tb, staph, klebsiella
RA, PE, squamous cell carcinoma
87
What might patients with polycythaemia present with?
headache
pruritis post hot bath
blurred vision
tinnitus
thombosis
grangrene
choreiform movements
88
what causes a low reticulocyte count?
parvovirus B19 infection (-\> aplastic crisis)
aplastic crisis 2nd to sickle cell
blood transfusion
89
What drug is used to treat prolactinoma?
cabergoline
90
CN I
* function
* S, M, B
* clinical
CN I - **olfactory**
* S
* function - smell (sensory
91
CN II
* function
* S, M, B
* clinical
CN II - **optic**
* S
* function - sight (S)
* via optic canal
92
CN III
* S, M, B
* function
* clinical
CN III - **oculomotor**
* M
* function
* eye movement (MOTOR)
* medial rectus, inferior oblique, superior rectus, inferior rectus
* pupil constriction
* accomodation
* eyelid opening
* clinical
* palsy - ptosis + down & out + dilated fixed pupil
93
CN IV
* S, M, B
* function
* clinical
CN IV - **trochlear**
* M
* function
* eye movement superior oblique
* clinical
* palsy - vertical diplopia, defective down gaze
94
CN V
* S, M, B
* function
* clinical
CN V - **trigeminal**
* B
* function
* S - facial sensation
* M - muscles of mastication
* corneal reflex (afferent)
* jaw jerk (efferent and afferent, mandibular branch)
* clinical
* loss of corneal reflex, loss of facial sensation, paralysis of muscles of mastication
* deviation of jaw towards weak side
95
CN VI
* S, M, B
* function
* clinical
CN VI - **abducens**
* M
* function
* eye movement - lateral rectus
* clinical
* defective abduction, horizontal diplopia
96
CN VII
* S, M, B
* function
* clinical
CN VII - **facial**
* B
* function
* S - taste anterior ⅔ tongue
* M - facial movement
* stapedius of the ear
* lacrimation, salivation
* clinical
* flaccid paralysis (forehead sparing UMN)
* loss of corneal reflex efferent arm
* loss of taste
* _hyperacusis_
97
CN VIII
* S, M, B
* function
* clinical
CN VIII - **vesticulocochlear**
* S
* function
* hearing
* balance
* clinical
* hearing loss
* vertigo, nystagmus
* acoustic neuroma, schwannoma
98
CN IX
* S, M, B
* function
* clinical
CN IX - **glossopharyngeal**
* B
* function
* S - taste posterior ⅓ tongue
* M - swallowing, mediates input from carotid body + sinus
* salivation
* clinical
* hypersensitive carotid sinus reflex
* loss of gag reflex
99
CN X
* S, M, B
* function
* clinical
CN X - **vagus**
* B
* function
* phonation
* swallowing - muscles of pharynx, soft palate and larynx
* innervates viscera
* clinical
* uvula deviation - away from site of lesion
* loss of gag reflex (efferent)
100
CN XI
* S, M, B
* function
* clinical
CN XI - **accessory**
* M
* function
* head and shoulder movement
* trapezius and sternocleidomastoid
* clinical
* weakness in turning head to contralateral side
101
CN XII
* S, M, B
* function
* clinical
CN XII
* M
* function
* tongue movement
* clinical
* tongue deviations to side of lesion
102
what are the ascending spinal tracts?
afferent
* dorsal column
* spinocerebellar tract
* anterolateral system
103
what are the descending spinal tracts?
descending
* pyramidal tracts (lateral and anterior corticospinal)
* extrapyramidal tracts
104
what is transmitted along dorsal columns?
deep touch
proprioception
vibration
105
what is transmitted along ventral spinothalamic
light touch
106
what is transmitted along the spinothalamic tract?
pain and temperatute
107
what are the cranial nerves?
1. olfactory
2. optic
3. oculomotor
4. trochlear nerve
5. trigeminal
6. abducens
7. facial nerve
8. vestibulocochlear
9. glossopharyngeal
10. vagus
11. accessory
12. hypoglossal
