extra Flashcards
what cardiac condition is common in systemic sclerosis
pulmonary fibrosis
CT in pulmonary fibrosis would show what
Performing a high resolution CT Chest may identify ground glass changes or honeycombing which would be consistent with pulmonary fibrosis
This is the correct answer. AL amyloidosis (primary amyloidosis) results in amyloid protein deposition in various tissues in the body, such as kidneys and the heart. It can lead to a restrictive cardiomyopathy that appears “sparkling” on an echocardiogram. This man has presented with symptoms of heart failure with a preserved ejection fraction (HFpEF). Amyloid deposition also causes arrhythmias and conduction disturbances.
amyloidosis
A 65-year-old man presents to the emergency department complaining of excruciating pain in his left leg. This came on suddenly whilst he was walking. He has a history of poorly controlled Type 2 diabetes mellitus, Hypercholesterolaemia, Myocardial infarction and peripheral vascular disease affecting both legs. He has a 24 pack-year smoking history. On examination, his left leg is pale and cold. Popliteal, posterior tibial and dorsalis pedis pulses are not palpable in the left leg. Despite opiate analgesia, the patient remains in severe pain.
What is the single most likely diagnosis?
acute limb ischaemia
This is the correct answer. This patient is displaying three of the ‘6P’s’: pain, (perishingly) cold, and pulseless. He has had a thrombosis in situ in one of the main arteries in his left leg, which can be a complication of peripheral vascular disease. This represents acute-on-chronic ischaemia of his left leg where blood supply has been completely cut off. Without intervention, this will lead to death of the limb and eventually, the patient
67%
explain intermittent claudication
This is the symptom of pain in the leg, which comes on with activity due to an inability to increase blood flow to the leg during increased activitiy. This is due to a narrowing of the arteries, typically due to atherosclerosis, causing peripheral vascular disease. Ischaemia in this situation is chronic but reversible on resting
You are the FY1 on vascular surgery. You are called to see a 58-year-old man who is two days post thrombolysis for acute limb ischaemia of his left leg. He is complaining of severe pain in his left leg, and his nurse reports that he has been requesting repeated doses of his PRN analgesia for the past few hours. He also complains of paraesthesia of the skin overlying his left leg.
On examination, his left leg appears red and swollen. There is severe pain on palpation of the muscles of the anterior aspect of his left leg, which feels tense and ‘woody’. Passive extension of his left toes produces excruxiating pain. Femoral, popliteal, posterior tibial, and dorsalis pedis pulse are palpable bilaterally.
Given the most likely diagnosis, what is the single best definitive management?
Four compartment fasciotomy
This is the correct answer. This patient has developed acute compartment syndrome secondary to reperfusion injury. This is a known complication which must be monitored for. A key examination finding is pain to passive stretching of muscles which is due to ischaemia.
Pulses are usually still felt, unless it is severe late compartment syndrome where intra-compartment pressures have exceeded systolic pressure. This can help distinguish it from an acutely ischaemic limb, which is pale, pulseless etc.
Prompt fasciotimy is the treatment; there are four compartments in the leg which require fasicial division
You are the FY1 on vascular surgery. You are called to see a 58-year-old man who is two days post thrombolysis for acute limb ischaemia of his left leg. He is complaining of severe pain in his left leg, and his nurse reports that he has been requesting repeated doses of his PRN analgesia for the past few hours. He also complains of paraesthesia of the skin overlying his left leg.
On examination, his left leg appears red and swollen. There is severe pain on palpation of the muscles of the anterior aspect of his left leg, which feels tense and ‘woody’. Passive extension of his left toes produces excruxiating pain. Femoral, popliteal, posterior tibial, and dorsalis pedis pulse are palpable bilaterally.
Given the most likely diagnosis, what is the single best definitive management?
Four compartment fasciotomy
This is the correct answer. This patient has developed acute compartment syndrome secondary to reperfusion injury. This is a known complication which must be monitored for. A key examination finding is pain to passive stretching of muscles which is due to ischaemia.
Pulses are usually still felt, unless it is severe late compartment syndrome where intra-compartment pressures have exceeded systolic pressure. This can help distinguish it from an acutely ischaemic limb, which is pale, pulseless etc.
Prompt fasciotimy is the treatment; there are four compartments in the leg which require fasicial division
acute limb ischameia
pale adn pulseness
comprtment sydnrome still feel pulses
inferior MI lead to what type of axis deviation
left
Incomplete blockade by a thrombus in one of the main coronary arteries
NSTEMI
Complete blockade by a thrombus in one of the coronary arteries
STEMI
A stable plaque, without the presence of a thrombus in one of the coronary arteries
exertional angina
if hypoxic give
oxygen
A 73-year-old female is admitted to hospital due to an ST-elevation myocardial infarction. She has primary percutaneous coronary intervention and following recovery is reviewed to commence drugs for the secondary prevention of cardiovascular disease.
Which dose of Atorvastatin should she be commenced on?
80mg
Interventricular septal rupture causing a ventricular septal defect is one of the acute complications of a myocardial infarction. Patients typically present with a
sx, ix and tx
new pan-systolic murmur and acute heart failure. Patients require an urgent echocardiogram to confirm the diagnosis and urgent surgical repair
Along with dual anti-platelet therapy, which form of anticoagulation should be given in the acute setting for an NSTEMI?
NICE guidance suggests the use of 1mg/kg BD of Low molecular weight heparin such as Enoxaparin / Fondaparinux (synthetic LMWH).
A 59 year old male patient presents to the emergency department with a 4 hour history of palpitations and chest discomfort. He has no past medical history of note.
Physical examination reveals a pulse rate of 100 beats per minute, blood pressure of 115/85mmHg, and respiratory rate of 18 breaths per minute. The pulse is irregularly irregular, but physical examination is otherwise unremarkable. The patient is discussed with the cardiologist and he is deemed suitable for electrical cardioversion. Trans-oesophageal echocardiogram rules out the presence of a left atrial thrombus.
Which of the following is the most suitable management option regarding anti-coagulation?
No need for anti-coagulation before or after cardioversion
This is the correct answer. The echo has excluded the presence of a left atrial thrombus and the patient has low thrombotic risk (CHA2DS2-VASc score = 0) so he can undergo immediate electrical cardioversion without the need for anticoagulation
atrial flutter ratio of p waves to QRS
2:1
common one off trigger of AF
alcohol
first line for paroxysmal AF
flecainide
fainting on exertion leads you to think
cardiac arrthymia
what else should you look at in an MI on ecg - hyperacute so if not in hosptial they shoudl be
The T waves in V2 + V3 are very large or ‘hyperacute’ to use the cardiology lingo. This is often the first change seen with myocardial ischaemia.
2+ blood on urinalysis is the right answer because haematuria is an example of target organ damage. NICE CKS guidelines for when a person’s blood pressure is 180/120 mmHg or higher state ‘‘If target organ damage is identified, consider starting antihypertensive drug treatment immediately,
