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ACC > Essential Conditions > Flashcards

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
Q

what is costochrondiritis

A

inflammation of the cartillage of the rib cage

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26
Q

how does it present

A

pain on contact or push on certain area of chest cartillage
pain on movement
radiates to back / abdomen

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27
Q

what are the complications of PE

A

right heart failure + cardiac arrest

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28
Q

how does PE present

A

dyspnoea
chest pain
hypoxaemia

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29
Q

what are features of a high risk PE

A

hypotension / syncope / tachycardia

signs of right heart failure

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30
Q

what is the definitive investigation for PE

A

CTPA

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31
Q

what is the management for haemodynamically unstable patients in PE

A

immediate reperfusion –> thrombolysis
anticoagulation
supportive care

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32
Q

what are the key risk factors for PE

A 
Active cancer 
recent surgery / hospitalisation 
previous DVT
pregenancy
obesity 
smoking
long-distance travel
smoking
COCP
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33
Q

what are important investigations for PE

A

D-dimer
FBC
CTPA

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34
Q

what are main differentials for PE

A

angina
MI
pneumonia
pericarditis

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35
Q

what are the wells score factors

A 
Clinical signs of DVT
Previous PE / DVT
HR > 100bpm
surgery / immobolisation 
haemopysis 
active cancer
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36
Q

what is the management for PE in haemodynamically unstable patients

A

respiratory support
–> high flow oxygen
Fluid resus
–> 500mL fluid challenge

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37
Q

what is the management for a haemodynamically stable PE

A
  1. unfractionated heparin
  2. Thrombolysis
  3. Switch to LMWH after a few hours for atleast 5 days
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38
Q

what can be done if thrombolysis fails

A

surgical embolectomy or purcutaneous catheter

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39
Q

which patients are admitted immediately with PE

A

pregnant or haemodynamically unstable

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40
Q

what do you do if there is a delay in CTPA

A

LMWH

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41
Q

what are the symptoms of pneumonia

A 
cough
dyspnoea 
pleuritic chest pain 
mucopurulent sputum
myalgia 
fever
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42
Q

What is the CRUB-65

A 
confusion - AMTS < 8
Urea > 7mmol
RR > 30
BP 90/60<
65 > yo
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43
Q

when should antibiotics be prescribed for patients with pneumonia

A

within 4 hours of presentation

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44
Q

when should sputum + blood cultures be sent for?

A

Moderate / high severity CAP

before antibiotics taken

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45
Q

what causes for pneumonia can be tested for in the urine

A

legionella + pneumococcal

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46
Q

what are auscultation findings on patients with pneumonia

A

crackles
decreased breath sounds
dullness to percussion
wheeze

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47
Q

what are the important investigations to request for patients with pneumonia

A

CxR < 4hrs admission –> consolidation
pulse oximetery
ABG
U+E

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48
Q

Why is it important to monitor the renal system in patients with pneumonia

A

significant risk factor for mortality

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49
Q

how does the route of antibiotics change based on the patient

A

high severity = IV

low severity = oral

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50
Q

what do the different CURB-65 scores mean

A 
>3 = admit to hospital 
1-2 = refer to hospital 
0 = treat at home
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51
Q

what is the supportive care for patients with pneumonia

A

NIV / CPAP unless they have resp failure

analgesia

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52
Q

what are the classic DVT symptoms

A 
asymmetrical leg 
swelling 
unilateral leg pain 
dilation of superficial veins
red skin
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53
Q

what is required for a DVT diagnosis

A

duplex ultrasound

CT

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54
Q

what is the treatment for DVT

A

anticoagulation

unfractionated heparin

55
Q

how long is anticoagulation continued for

A

3-6 months

56
Q

what is the wells score criteria

A 
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
Q

what do the scores from a wells score mean

A

> 2 DVT likely

< 2 DVT unlikely

58
Q

what are the invesigations that should be done in DVT

A 
D-dimer 
duplex ultrasound 
INR + aPTT
U+E
LFTs
FBC
59
Q

what is the purpose of anticoagulation treatment for patients with DVT

A

prevent progression of thrombus
reduce risk of PE
reduce risk of recurrent DVT

60
Q

what are the three phases of anticoagulation therapy for DVT

A
  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
Q

what is a complication of using anticoagulants

A

massive haemorrhage

62
Q

what is the order of preferred treatment for DVT

A
  1. DOACs
  2. warfarin
  3. LMWH
63
Q

what is the treatment for DVT

A
  1. anticoagulation
  2. physical activity
  3. gradient stockings
64
Q

what is cellulitis key features

A

indistinct borders
dermis + SC tissue
erythema / oedema / warmth / tenderness

65
Q

what are risk factors for cellultis

A

previous cellulitis
ulcer/wound
lymphoedema
venous insufficiency

66
Q

what are the key investigations to perform

A

FBC - raised WCC

culture if cellulitis near wound / pustular focus

67
Q

what is cellulitis treatment for patients that are severely ill

A

parenteral ABx with MRSA cover

68
Q

what is the biochemical triad of DKA

A

hyperglycaemia
ketonaemia
acidaemia

69
Q

what are the common signs + symptoms of DKA

A 
polyuria 
polydipsia 
polyphagia 
weakness
weight loss
tachycardia 
dry mucous membranes 
poor skin turgor 
hypotension 
shock
70
Q

what are the principles for DKA treatment

A

fluids
glucose
stable
frequent monitoring

71
Q

what are complications of DKA treatment

A 
hypoglycaemia 
hypokalaemia 
hypoxaemia 
pulmonary oedema 
cerebral oedema
72
Q

what are the risk factors for DKA

A

poor insulin therapy
infection
MI
drug interactions

73
Q

what are the key investigations for DKA

A 
plasma glucose >13.9
ABG acidosis 
urinalysis --> glucose + ketones 
urea + creatinine --> increased
electrolytes --> depleted
74
Q

when can insulin be applied in patients with DKA

A

potassium > 3.3

75
Q

at what rate should fluid be given

A

1-1.5L/hr

76
Q

what are indications for ICU admission

A 
haemodynamic instability 
cardiogenic shock
altered mental status 
respiratory insufficiency 
severe acidosis 
hyperosmolar state
77
Q

how to give insulin therapy safely in DKA patients

A

exclude hypokalaemia
give infusuin slowly
stop insulin if K+ falls below 3.3

78
Q

how regularly should DKA patients be monitored

A
  1. Hourly
    serum glucose + electrolytes
  2. 2 - 6 hours
    urea / creatinine / ketones
79
Q

what are the aims of DKA biochemical treatment

A

glucose < 11.1
bicarb > 18
pH > 7.3
anion gap < 10

80
Q

what is the treatment for DKA

A 
IV fluids 
potassium therapy 
IV insulin 
vasopressors 
bicarb therapy 
phosphate therapy
81
Q

how does hypoglycaemia present

A

nausea / confusion / tremor / sweating / palpitations / hunger

82
Q

what is the glucose level for hypoglycaemia

A

<3.3

83
Q

whats whipples triad for hypoglycaemia

A

hypoglycaemic symptoms
low glucose
resolution of symptoms once glucose given

84
Q

what are risk factors fro hypoglycaemia

A

middle age / female / alcohol consumption / bariatirc surgery

85
Q

what investigations would you do for a patient with hypoglycaemia

A

serum glucose
LFT
renal function test
serum insulin

86
Q

how is hypoglycaemia treated

A

glucagon + supportive therapy

87
Q

what is hypoglycaemia management for unconscious patient

A

15-20mg of quick acting carb
test glucose after 10-15min
if still low repeat 3 times
if still unsucessful try IV glucose

88
Q

when not to useglucagon in patients with hypoglycaemia

A

takes up to 15min to work
ineffective in undernourished patients
severe liver disease

89
Q

how is severe hypoglycaemia treated

A

IV glucose over 10min

20% 100ml

90
Q

what are symptoms of paracetamol overdose

A

asymptomatic
mild GI symptoms
progresses to Liver injury –> liver failure

91
Q

what is the treatment of paracetamol overdose

A

acetylcysteine

92
Q

what is defined as a paracetamol overdose

A

4g in 24hours

93
Q

what are the signs of hepatic failure in paracetamol overdose patents

A

RUQ pain
jaundice
confusion
astexis

94
Q

what are risk factors for paracetamol overdose

A

history of self-harm

inducers of p450

95
Q

what investigations would you do for patients with paracetamol overdose

A 
serum paracetamol 
AST / ALT
pH / lactate 
U+ E
prothrombin time + INR
urine drug screen
96
Q

what is the management for acute paracetamol overdose

A 
acetylcysteine 
supportive care
anti-emetic 
activated charcoal 
evaluation for liver transplant
97
Q

what are symptoms of alcohol withdrawal

A 
anxiety 
nausea 
vomitting 
insomnia 
autonomic dysfunction
98
Q

what are severe symptoms of withdrawal

A

seizures
psychaitric disturbance
delrium tremens

99
Q

what is the treatment for alcohol withdrawal

A

chlorpiazode

100
Q

when do alcohol withdrawal symptoms present

A

6-12 hours after last drink

101
Q

what are diagnostic factors for alcohol withdrawal

A 
tremor finger tips / whole hand moving 
tachycardia 
sweating 
palpitations
headache 
anorexia 
depression
102
Q

what investigations for alcohol withdrawal

A 
VBG
glucose 
FBC
U+E --> hypomagnesaemia / hypokalaemia / hypophosphataemia 
LFT 
bone profile
coagulation study
103
Q

what is the key medical management for alcohol withdrawal

A 
benzo
thiamine 
add antipsychotic 
consider rapid tranq
CT head
104
Q

what is the supportive care for alcohol withdrawal

A 
quiet room 
monitor for deterioration 
rehydrate patient 
correct electrolyte imbalance 
correct BG
105
Q

what quantity should patients try and reduce their alcohol by

A

25% every 2 weeks

106
Q

social treatment for alcoholism

A 
regular meetings 
self-help groups
family + carer involvement
regular monitoring 
long term plan
107
Q

what should be done within an hour of suspected sepsis

A 
2 sets of blood cultures
serum lactate on ABG 
measure urine output hourly 
IV broad spectrum Abx
fluids 
oxygen
108
Q

where are the most common sources of sepsis

A 
resp
urinary 
upper GU 
SSRI
surgical site
109
Q

what are the key symptoms of sepsis

A 
NEWS > 5
tachypnoea 
high temp
tachycardia 
altereed mental status 
low oxygen sats 
hypotension 
poor cap refill
cyanosisi
110
Q

what are the investigations for sepsis

A 
blood cultures - before Abx sample/ two different sites
ABG - lactate 
hourly urine output 
FBC 
U+E
glucose 
CRP
LFT 
clottingscreen 
ECG
111
Q

what is the rule for giving fluids for patients with sepsis

A

500ml crystalloid with sodium over 15min
repeat if clinically indicated
do not exceed 30mL/kg

112
Q

what is AKI associated with

A

hypovolaemia
hypotension
nephtotoxic
urinary outflow obstruction

113
Q

when should you suspect AKI

A

rise in serum creatinine

fall in urine output

114
Q

what are complications of AKI

A

hyperkalaemia
uraemic encephalopathy
pericarditis

115
Q

what is the principle of managing AKI

A 
supportive care 
treat underlying cause 
optimise volume status
correction of acidaemia 
electrolyte complications 
avoidance of nephrotoxins 
relief of any obstruction
116
Q

what is the treatment for severe AKI

A

RRT

117
Q

What are the risk factors for AKI

A

> 65
CKD
previus AKI
NSAID / aminoglycoside ABx / ACEi/ diuretic

118
Q

what sort of patients does AKI effect

A

acutely ill

119
Q

what to look out for in AKI

A

reduced urine ouput

120
Q

what are the key investigations for AKI

A

U+ E –> acute rise in creatinine

urine output decrease

121
Q

what is stage 1 AKI

A

SCr rise of > 26 within 48hrs

122
Q

what is stage 2 AKI

A

SCr increase > 3 times baseline

123
Q

what is stage 3 AKI

A

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
Q

what is management for hypovolaemic AKi

A
  1. fluid resus
  2. review medications and stop nephrotixic
  3. identify and treat underlying causes
125
Q

what does STOP AKI stand for

A

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
Q

how to treat obstructive cause of AKI

A

ultrasound
bladder catheter
refer to urology

127
Q

how to manage hyperkalaemia

A 
monitor ECG
immediate calcium gluconate 
IV insulin / glucose 
withold causing agent 
RRT if severe
128
Q

what is delirium

A

acute / fluctuating change in mental status / altered level of consciousness

129
Q

4 defining features of delirium

A

disturbance in attention
change in cognition
acute
evidence of change from history / exam / lab findings

130
Q

types of delirium

A
  1. Hyperactive
    - heightened arousal
    - restlessness / agitation / hallucinations / inappropriate behaviour
  2. Hypoactive
    - lethargy / reduced motor activity / incoherent speech
  3. mixed
    - both
131
Q

differentials for delirium

A 
dementia 
Stroke
Mi
hypoglycaemia
hyperglycaemia
hypercapnia
132
Q

causes of delirium

A 
D - drugs
E- poor hearing + vision 
L - low O2
I - infection 
R- retention 
I -ical state
U - under-hydration/ nutrition 
M - metabolic
133
Q

common differentials for confusion

A 
stroke
head injury 
siezures 
MI
CHF
ventricular arrthymias
134
Q

what are the key investigations for delirium

A 
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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