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Essential Conditions Flashcards

1
Q

what is a STEMI

A

complete occulusion of coronary supply

persistent ST elevation in atleast 2 leads

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2
Q

Typical symptoms of unstable angina

A

chest pain + dyspnoea

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3
Q

classic ECG signs of unstable angina

A

ST depression + T-wave inversion

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4
Q

what is the acute management for unstable angina

A

antiplatelet + antithrombotic therapy

reduces myocardial damage and complications

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5
Q

what is unstable angina defined by

A

absence of troponin rise
>20min angina at rest
or nuance in presentation

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6
Q

risk factors for ACS

A

female / increased age / positive family history / CAD history / HTN / diabetes / hyperlipidaemia / obesity / smoking

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7
Q

what heart sound is present in unstable angina

A

4th heart sound

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8
Q

when should the ECG be taken

A

<10min from chest pain onset

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9
Q

when should troponin be measured and what will the result be in unstable angina

A

0 hours / 3

no rise in trop

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10
Q

what other bloods should be taken in unstable angina

A

FBC - would be normal
U+E - baseline + risk stratification
blood sugar - normal

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11
Q

what is gold standard investigation for CAD

A

coronary angiography

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12
Q

what medications should be given to patients before they arrive to hospital

A

aspirin + GTN

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13
Q

what medications should be given to patients when they arrive in hospital

A

Oxygen
aspirin
clopidogrel
morphine

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14
Q

what is the definitive management for a STEMI

A

primary PCI pr fibrinolytics

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15
Q

what is the timing for fibrinolytic therapy

A

<30 min

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16
Q

when should PCI be used

A

<90min

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17
Q

what should happen to trop negative + normal ECG patients

A

monitor on regular

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18
Q

what are the rules for Beta blocker usage post MI

A

1st line anti-ischaemic drugs

start within first 24hr

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19
Q

when should beta blockers not be used

A 
signs of HF
low output state
increased risk for cardiogenic shock 
heart block
active asthma
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20
Q

what is the treatment algorithm for unstable angina

A
  1. Oxygen + nitrates + morphine
  2. Beta blocker
  3. anti-platelet therapy
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21
Q

what confirms the diagnosis of STEMI

A

troponin but do not wait for results before starting treatment

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22
Q

what does MSK chest pain present as

A

pain on palpation

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23
Q

what are classic MSK chest pain symptoms

A

pain on movement

pain on deep breath / sneeze / coughing

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24
Q

what are examples of MSK chest chest pain

A 
injury
costochrondritis 
tietze's syndrome 
pulled muscle
stress fracture
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25
what is costochrondiritis
inflammation of the cartillage of the rib cage
26
how does it present
pain on contact or push on certain area of chest cartillage pain on movement radiates to back / abdomen
27
what are the complications of PE
right heart failure + cardiac arrest
28
how does PE present
dyspnoea chest pain hypoxaemia
29
what are features of a high risk PE
hypotension / syncope / tachycardia | signs of right heart failure
30
what is the definitive investigation for PE
CTPA
31
what is the management for haemodynamically unstable patients in PE
immediate reperfusion --> thrombolysis anticoagulation supportive care
32
what are the key risk factors for PE
``` Active cancer recent surgery / hospitalisation previous DVT pregenancy obesity smoking long-distance travel smoking COCP ```
33
what are important investigations for PE
D-dimer FBC CTPA
34
what are main differentials for PE
angina MI pneumonia pericarditis
35
what are the wells score factors
``` Clinical signs of DVT Previous PE / DVT HR > 100bpm surgery / immobolisation haemopysis active cancer ```
36
what is the management for PE in haemodynamically unstable patients
respiratory support --> high flow oxygen Fluid resus --> 500mL fluid challenge
37
what is the management for a haemodynamically stable PE
1. unfractionated heparin 2. Thrombolysis 3. Switch to LMWH after a few hours for atleast 5 days
38
what can be done if thrombolysis fails
surgical embolectomy or purcutaneous catheter
39
which patients are admitted immediately with PE
pregnant or haemodynamically unstable
40
what do you do if there is a delay in CTPA
LMWH
41
what are the symptoms of pneumonia
``` cough dyspnoea pleuritic chest pain mucopurulent sputum myalgia fever ```
42
What is the CRUB-65
``` confusion - AMTS < 8 Urea > 7mmol RR > 30 BP 90/60< 65 > yo ```
43
when should antibiotics be prescribed for patients with pneumonia
within 4 hours of presentation
44
when should sputum + blood cultures be sent for?
Moderate / high severity CAP | before antibiotics taken
45
what causes for pneumonia can be tested for in the urine
legionella + pneumococcal
46
what are auscultation findings on patients with pneumonia
crackles decreased breath sounds dullness to percussion wheeze
47
what are the important investigations to request for patients with pneumonia
CxR < 4hrs admission --> consolidation pulse oximetery ABG U+E
48
Why is it important to monitor the renal system in patients with pneumonia
significant risk factor for mortality
49
how does the route of antibiotics change based on the patient
high severity = IV | low severity = oral
50
what do the different CURB-65 scores mean
``` >3 = admit to hospital 1-2 = refer to hospital 0 = treat at home ```
51
what is the supportive care for patients with pneumonia
NIV / CPAP unless they have resp failure | analgesia
52
what are the classic DVT symptoms
``` asymmetrical leg swelling unilateral leg pain dilation of superficial veins red skin ```
53
what is required for a DVT diagnosis
duplex ultrasound | CT
54
what is the treatment for DVT
anticoagulation | unfractionated heparin
55
how long is anticoagulation continued for
3-6 months
56
what is the wells score criteria
``` active cancer calf swelling > 3cm than other calf prominent superficial veins pitting oedema swelling of entire leg localised pain along deep venous sytem recent immobilisation recent surgery previous DVT alternative diagnosis least probable ```
57
what do the scores from a wells score mean
> 2 DVT likely | < 2 DVT unlikely
58
what are the invesigations that should be done in DVT
``` D-dimer duplex ultrasound INR + aPTT U+E LFTs FBC ```
59
what is the purpose of anticoagulation treatment for patients with DVT
prevent progression of thrombus reduce risk of PE reduce risk of recurrent DVT
60
what are the three phases of anticoagulation therapy for DVT
1. Initiation 5-21 days arrest active prothrombotic state and inhibit thrombus propagation 2. Long term initiation to 3 months prevent new thrombus formation 3. extended prevent new VTE
61
what is a complication of using anticoagulants
massive haemorrhage
62
what is the order of preferred treatment for DVT
1. DOACs 2. warfarin 3. LMWH
63
what is the treatment for DVT
1. anticoagulation 2. physical activity 3. gradient stockings
64
what is cellulitis key features
indistinct borders dermis + SC tissue erythema / oedema / warmth / tenderness
65
what are risk factors for cellultis
previous cellulitis ulcer/wound lymphoedema venous insufficiency
66
what are the key investigations to perform
FBC - raised WCC | culture if cellulitis near wound / pustular focus
67
what is cellulitis treatment for patients that are severely ill
parenteral ABx with MRSA cover
68
what is the biochemical triad of DKA
hyperglycaemia ketonaemia acidaemia
69
what are the common signs + symptoms of DKA
``` polyuria polydipsia polyphagia weakness weight loss tachycardia dry mucous membranes poor skin turgor hypotension shock ```
70
what are the principles for DKA treatment
fluids glucose stable frequent monitoring
71
what are complications of DKA treatment
``` hypoglycaemia hypokalaemia hypoxaemia pulmonary oedema cerebral oedema ```
72
what are the risk factors for DKA
poor insulin therapy infection MI drug interactions
73
what are the key investigations for DKA
``` plasma glucose >13.9 ABG acidosis urinalysis --> glucose + ketones urea + creatinine --> increased electrolytes --> depleted ```
74
when can insulin be applied in patients with DKA
potassium > 3.3
75
at what rate should fluid be given
1-1.5L/hr
76
what are indications for ICU admission
``` haemodynamic instability cardiogenic shock altered mental status respiratory insufficiency severe acidosis hyperosmolar state ```
77
how to give insulin therapy safely in DKA patients
exclude hypokalaemia give infusuin slowly stop insulin if K+ falls below 3.3
78
how regularly should DKA patients be monitored
1. Hourly serum glucose + electrolytes 2. 2 - 6 hours urea / creatinine / ketones
79
what are the aims of DKA biochemical treatment
glucose < 11.1 bicarb > 18 pH > 7.3 anion gap < 10
80
what is the treatment for DKA
``` IV fluids potassium therapy IV insulin vasopressors bicarb therapy phosphate therapy ```
81
how does hypoglycaemia present
nausea / confusion / tremor / sweating / palpitations / hunger
82
what is the glucose level for hypoglycaemia
<3.3
83
whats whipples triad for hypoglycaemia
hypoglycaemic symptoms low glucose resolution of symptoms once glucose given
84
what are risk factors fro hypoglycaemia
middle age / female / alcohol consumption / bariatirc surgery
85
what investigations would you do for a patient with hypoglycaemia
serum glucose LFT renal function test serum insulin
86
how is hypoglycaemia treated
glucagon + supportive therapy
87
what is hypoglycaemia management for unconscious patient
15-20mg of quick acting carb test glucose after 10-15min if still low repeat 3 times if still unsucessful try IV glucose
88
when not to useglucagon in patients with hypoglycaemia
takes up to 15min to work ineffective in undernourished patients severe liver disease
89
how is severe hypoglycaemia treated
IV glucose over 10min | 20% 100ml
90
what are symptoms of paracetamol overdose
asymptomatic mild GI symptoms progresses to Liver injury --> liver failure
91
what is the treatment of paracetamol overdose
acetylcysteine
92
what is defined as a paracetamol overdose
4g in 24hours
93
what are the signs of hepatic failure in paracetamol overdose patents
RUQ pain jaundice confusion astexis
94
what are risk factors for paracetamol overdose
history of self-harm | inducers of p450
95
what investigations would you do for patients with paracetamol overdose
``` serum paracetamol AST / ALT pH / lactate U+ E prothrombin time + INR urine drug screen ```
96
what is the management for acute paracetamol overdose
``` acetylcysteine supportive care anti-emetic activated charcoal evaluation for liver transplant ```
97
what are symptoms of alcohol withdrawal
``` anxiety nausea vomitting insomnia autonomic dysfunction ```
98
what are severe symptoms of withdrawal
seizures psychaitric disturbance delrium tremens
99
what is the treatment for alcohol withdrawal
chlorpiazode
100
when do alcohol withdrawal symptoms present
6-12 hours after last drink
101
what are diagnostic factors for alcohol withdrawal
``` tremor finger tips / whole hand moving tachycardia sweating palpitations headache anorexia depression ```
102
what investigations for alcohol withdrawal
``` VBG glucose FBC U+E --> hypomagnesaemia / hypokalaemia / hypophosphataemia LFT bone profile coagulation study ```
103
what is the key medical management for alcohol withdrawal
``` benzo thiamine add antipsychotic consider rapid tranq CT head ```
104
what is the supportive care for alcohol withdrawal
``` quiet room monitor for deterioration rehydrate patient correct electrolyte imbalance correct BG ```
105
what quantity should patients try and reduce their alcohol by
25% every 2 weeks
106
social treatment for alcoholism
``` regular meetings self-help groups family + carer involvement regular monitoring long term plan ```
107
what should be done within an hour of suspected sepsis
``` 2 sets of blood cultures serum lactate on ABG measure urine output hourly IV broad spectrum Abx fluids oxygen ```
108
where are the most common sources of sepsis
``` resp urinary upper GU SSRI surgical site ```
109
what are the key symptoms of sepsis
``` NEWS > 5 tachypnoea high temp tachycardia altereed mental status low oxygen sats hypotension poor cap refill cyanosisi ```
110
what are the investigations for sepsis
``` blood cultures - before Abx sample/ two different sites ABG - lactate hourly urine output FBC U+E glucose CRP LFT clottingscreen ECG ```
111
what is the rule for giving fluids for patients with sepsis
500ml crystalloid with sodium over 15min repeat if clinically indicated do not exceed 30mL/kg
112
what is AKI associated with
hypovolaemia hypotension nephtotoxic urinary outflow obstruction
113
when should you suspect AKI
rise in serum creatinine | fall in urine output
114
what are complications of AKI
hyperkalaemia uraemic encephalopathy pericarditis
115
what is the principle of managing AKI
``` supportive care treat underlying cause optimise volume status correction of acidaemia electrolyte complications avoidance of nephrotoxins relief of any obstruction ```
116
what is the treatment for severe AKI
RRT
117
What are the risk factors for AKI
>65 CKD previus AKI NSAID / aminoglycoside ABx / ACEi/ diuretic
118
what sort of patients does AKI effect
acutely ill
119
what to look out for in AKI
reduced urine ouput
120
what are the key investigations for AKI
U+ E --> acute rise in creatinine | urine output decrease
121
what is stage 1 AKI
SCr rise of > 26 within 48hrs
122
what is stage 2 AKI
SCr increase > 3 times baseline
123
what is stage 3 AKI
SCr increase to ≥3 times baselineor SCr rise to ≥354 micromol/Lor Patient initiated on RRT (irrespective of AKI stage at time of initiation)
124
what is management for hypovolaemic AKi
1. fluid resus 2. review medications and stop nephrotixic 3. identify and treat underlying causes
125
what does STOP AKI stand for
sepsis - implement buffalo toxins - stop/avoid nephrotoxins O - optimise BP --> fluids / hold antihypertensive meds + diuretics + consider vasopressors P -prevent harm - relief Urinary tract obstruction / hyperkalaemia / acidosis
126
how to treat obstructive cause of AKI
ultrasound bladder catheter refer to urology
127
how to manage hyperkalaemia
``` monitor ECG immediate calcium gluconate IV insulin / glucose withold causing agent RRT if severe ```
128
what is delirium
acute / fluctuating change in mental status / altered level of consciousness
129
4 defining features of delirium
disturbance in attention change in cognition acute evidence of change from history / exam / lab findings
130
types of delirium
1. Hyperactive - heightened arousal - restlessness / agitation / hallucinations / inappropriate behaviour 2. Hypoactive - lethargy / reduced motor activity / incoherent speech 3. mixed - both
131
differentials for delirium
``` dementia Stroke Mi hypoglycaemia hyperglycaemia hypercapnia ```
132
causes of delirium
``` D - drugs E- poor hearing + vision L - low O2 I - infection R- retention I -ical state U - under-hydration/ nutrition M - metabolic ```
133
common differentials for confusion
``` stroke head injury siezures MI CHF ventricular arrthymias ```
134
what are the key investigations for delirium
``` MMSE - rule out dementia CT head - rule out vascular causes ECG / trop - rule out cardiac cause FBC - rule out infection U+E- rule out metabolic causes Blood glucose - rule out hypo/hyperglycaemia LFT - hepatic encephalopathy ```

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