FANZCA Med Viva core Flashcards
What is aortic sclerosis?
History features for Aortic Stenosis?
- Chest pain/Angina, Dyspnoea, Syncope
- decreased exercise tolerance due to inability of heart to adeqautely increase SV to meet metabolic demands
- rheumatic fever
- risk factors similar to those of IHD (htn, ^cholesterol)
Exam features for Aortic Stenosis
Pulse: plateau or anacrotic pulse or pulse may be late peaking and of small volume
Palpation: displaced hyperdynamic apex beat, thrill over aortic area
Auscultation
- narrowly split or reveresed S2 becasue of delayed LV ejection
- Mid-systoli ejection murmur maximal over aortic area + extending to carotids
- murmur loudest with patient sitting up in full expiration
Ix for aortic stenosis
ECG: LVH + strain
CXR: normal until LV begins to fail, may see calcified aortic annulus or prominent ascending aorta from post-stenotic aortic dialtion
Echo: trileaflet vs. bileaflet aortic valve, thickening and calcification of aortic valve, decreased mobility of aortic valve leaflets, LV hypertrophy and LV systolic or diastolic dysfunction, measurement of AVA + transvalvular pressure gradients
Cardiac Cath: may be necessary when severity cannot be determined by echo
How is the severity of aortic stenosis assessed
- symptoms do not correlate well with stenosis severity, patients with severe disease can be asymptomatic
- symptoms and average time to death post onset:
> exertional angina = 5 yrs
> exertional syncope = 3 yrs
> exertional dyspnoea = 2 years - signs indicating severe AS:
> thrill in aortic area
> LV failure (very late sign)
> paradoxical splitting of S2
> late peaking murmur
> presence of S4 - Echo
AVA cm2:
> 1.5= mild
1.0-1.5= Mod
<1.0 = severe
iAVA
<0.6 = severe
Mean gradient(mmHg)
<25 =mild
25-40 =mod
>40= Severe
Jet Velocity (m/s);
mild= <3
mod= 3-4
Sev= >4
Exercise stress testing
- not suitable for symptomatic patients, may be used to evaluate asymptomatic patients, hypotension or failure to increase BP with exercise = poor prognostic finding
Stages of Aortic Stenosis
A: at risk of AS
B: Progressive AS
C1: Asymptomatic Severe AS
C2: Asymptomatic Severe AS with LV dysfunction
D1: Symptomatic Severe high gradient AS
D2: Symptomatic Severe low-flow/low-gradient AS with reduced LVEF
D3: Symptomatic severe low-gradietn AS with normal LVEF or paradoxical low-flow severe AS
What is the avg rate of haemodynamic progression in pts diagnosed with AS
Treatment of Aortic stenosis
- No medical treatment will improve or halt progression
-> avoidance of strenuous activity in severe AS
-> sodium restriction if heart failure present
-> gentle diuresis for volume overload as preload dependent
-> control hypertension but avoid vasodilators
->maintain sinus rhythm - Symptomatic patients require surgery because there is a 50% mortality rate at 2 years with medical therapy alone
-> Aortic Valve replacement is a class 1 indication for patients with:
1. symptomatic severe AS
2. asymptomatic severe AS with LVEF <50%
3. asymptomatic severe AS undergoing CABG or surgery on the aorta or other heart valves
-> TAVR has been shown to reduce mortality by 20% in patients with severe AS + coexisting conditions that exclude them as candidates for SAVR (surgical)
-> percutaneous aortic balloon valvuloplasty serves best as palliative therapy in severe symptomatic patients who are not surgical candidates + as a bridge to surgery in haemodynamicaly unstable adult patients
Anaesthesia goals for Aortic Stenosis
Dynamic manoeuvres to differentiate systolic murmurs
Causes of Mitral Regurgitation?
History for Mitral Regurgitation?
Examination for Mitral Regurgitation
Severity grading for Mitral Regurgitation
Stages for Mitral Regurgitation?
Medical management for Mitral Regurgitation?
Surgical management of Mitral Regurgitation
Causes of Mitral Stenosis
Hx for Mitral Stenosis
Ex for Mitral Stenosis
Ix of Mitral Stenosis
Severity of Mitral Stenosis
Staging of Mitral Stenosis
Medical management of Mitral Stenosis
Surgical Management of Mitral Stenosis
Hx and Ex for Aortic Regurgitation
Ix for Aortic Regurgitation
Severity and staging of Aortic Regurgitation
Medical mgmt of Aortic Regurgitation
Surgical Mgmt of Aortic Regurgitation
Which patients more typically have systolic versus diastolic heart failure?
Examination findings for LVF vs RVF?
Criteria for LVH on ECG
Voltage Criteria
Limb Leads
- R wave in lead I + S wave in lead III > 25 mm
- R wave in aVL > 11 mm
- R wave in aVF > 20 mm
- S wave in aVR > 14 mm
Precordial Leads
- R wave in V4, V5 or V6 > 26 mm
- R wave in V5 or V6 plus S wave in V1 > 35 mm (Sokolov-Lyon criteria)
- Largest R wave plus largest S wave in precordial leads > 45 mm
Non Voltage Criteria
- Increased R wave peak time > 50 ms in leads V5 or V6
- ST segment depression and T wave inversion in the left-sided leads: AKA the left ventricular ‘strain’ pattern
Ix for CCF
Severity classification for CCF
Management for CCF
Ix for a pt with a Hx of Ischaemia
Angina severity
Management for a pt with a hx of IHD?
Risk Factors for IHD
How do you manage coronary stents perioperatively?
Indications for thrombolysis
Classifications of cardiomyopathies?
Dilated Cardiomyopathy causes
Dilated Cardiomyopathy Hx and Ex
Dilated Cardiomyopathy Ix
Management of Dilated Cardiomyopathy
Hx and Ex for Hypertrophic Obstructive Cardiomyopathy
Ix for Hypertrophic Obstructive Cardiomyopathy
Treatment of Hypertrophic Obstructive Cardiomyopathy
Causes of restrictive cardiomyopathy
Hx and Ex for Restrictive Cardiomyopathy
Ix for restrictive cardiomyopathy
Anaesthesia for Restrictive Cardiomyopathy
What is AF?
Risk factors for AF
AF classification
Hx and Ex for AF
Ix for AF
Severity of AF?
CHADS2 and CHADSVaSc
Anaesthetic considerations and AF
Antiarrhythmic Classification
PPM indications
ICD Indications
Anaesthesia and a PPM/ICD
What is Long QT syndrome
Hx for Long QT syndrome
DDx for long QT
Operative management of long QT
Drugs that alter the QT
What is Brugada Syndrome?
Dx for Brugada
Presentation of Brugada
Anaesthetic Considerations for Brugada
What is pulmonary hypertension
Hx and Ex for pulm Hypertension
Ix for Pulm Htn
Classification of pulm HTN
Severity of pulm HTN
Variables used to determine the prognosis of pulm HtN
Medical mgmt for pulm Htn
Surg Rx for pulm HTN
Perioperative M&M for pulm HTN
Predictors of a poor outcome in non-cardiac surgery and pulm HTN
Intra-op goals for pulm HTN
Management options for intra op pulm hypertensive crisis
Hx for Peripheral Vascular Disease
Ex for Peripheral Vascular Disease
Ix and severity of Peripheral Vascular Disease
Management of Peripheral Vascular Disease
Anaesthesia for Peripheral Vascular Disease
Hx and Ex for Atrial Septal Defect
Ix and severity for Atrial Septal Defect
Anaesthesia in the context of an Atrial Septal Defect
Ventricular Septal Defect incidence and examination features
Ventricular Septal Defect Ix and severity
Anaesthetic considerations for a Ventricular Septal Defect
Causes of heart transplant and survival
Hx for a heart transplant recipient
Ex for a heart transplant recipient
Ix for a heart transplant recipient
Post heart transplant management
Anaesthetic considerations for a post transplant patient
Characteristics of emphysema vs chronic bronchitis
RFs for COPD
Hx for COPD
Ex for COPD
Ix for COPD-all
mMRC dyspnoea scale
Severity of COPD
Rx COPD
GOLD ABCD criteria
Criteria for Oxygen therapy with COPD
RFs for post-op pulm comp in the context of COPD
Risk reduction strategies to decrease the incidence of post-op pulm complications
Diagnostic criteria for RVH on an ECG
What is bronchiectasis and its causes
Hx for Bronchiectasis
Ex for Bronchiectasis
Ix for Bronchiectasis
Rx for bronchiectasis
Anaesthetic considerations for bronchiectasis
Hx asthma
Ex asthma
Ix asthma
Asthma severity
Causes of Restrictive Lung Disease
Hx Restrictive Lung Disease
Ex Restrictive Lung Disease
Ix Restrictive Lung Disease
Anaesthetic considerations for Restrictive Lung Disease
Pneumothorax classification
Pneumothorax Hx
Pneumothorax Ex
Pneumothorax Ix and severity
What is OSA
OSA Hx and Ex
OSA Ix
OSA Rx
Causes of OSA
RFs for OSA
STOP BANG questionnaire
Components of a polysomnogram
Cystic Fibrosis associated mortality?
Hx for Cystic Fibrosis
Ex for Cystic Fibrosis
Ix for Cystic Fibrosis
Dx of Cystic Fibrosis
Cystic Fibrosis Rx
Hx for lung Cancer
Ex for Lung Cancer
Ix for lung Cancer
Post lung surgery management based on ppoFEV1
Flow volume loop for emphysema
Flow volume loop for unilateral main-stem bronchial obstruction
Flow volume loop for upper airway obstruction
Flow volume loop for a variable extrathoracic upper airway obstruction
Flow volume loop for a variable intrathoracic upper airway obstruction
Flow volume loop for a restrictive lung disease
Flow volume loop for neuromuscular weakness
Hx for lung transplant
Ex for lung transplant
Ix post lung transplant
Mgmt post lung transplant
Types of acute liver failure and the syndrome that occurs with it?
Hx for liver failure
Ex for liver failure
Ix for liver failure
Kings colleg criteria for selection of liver transplant recipients
Causes of chronic cirrhosis
Hx for Chronic Liver Disease
Ex for Chronic Liver Disease
Ix for Chronic Liver Disease
Severity of Chronic Liver Disease as per childs pugh and prognosis
Severity of Chronic Liver Disease as per MELD
Paeds liver failure scoring?
Complications of CLD
Rx for CLD
Effects of haemochromotosis
Hx for haemochromotosis
Ex for haemochromotosis
Ix for haemochomatosis
Rx for haemachromotosis
What is wilsons and the results of it?
Hx for wilsons
Ex and Ix for wilsons
Rx for wilsons
Hep C Hx and Ex
Hep C Ix and Rx
Hep B overview
CKD causes
CKD Hx
CKD Ex
Ix for CKD
CKD Mgmt
CKD mgmt based on eGFR
Systemic Manifestations of CKD
Findings suggestive of inadequate haemodialysis
Hx in a haemodialysis pt
Ex for a haemodialysis pt
Ix for a haemodialysis pt
Optimisation for a haemodialysis pt
Cause of acromegaly
Hx for acromegaly.
Ex for acromegaly.
Ix for acromegaly
Signs of active acromegaly
Rx of acromegaly
Causes of acromegaly?
Diabetes types
Diabetes history
Diabetes Ex
Diabetes criteria
Complications of diabetes
Diagnostic triad of DKA and typical breathing patter
Hyperparathyroid classification
Symptoms of hypercalcaemia
Rx for hypercalcaemia?
Rx for hypercalcaemia
Causes of hypoparathyroidism
Hx and exam for hypocalcaemia
Causes of hypercalcaemia?
Causes of hypocalcaemia?
Causes of hyperthyroidism
Thyroid neck exam
Hyperthyroid systemic exam
Hyperthyroid Ix
Hypothyroid causes
Hypothyroid systemic exam
Hypothyroid Ix
Hypothyroidism Rx
Causes of Cushings
Hx and Ex for cushings
Ix and Dx for cushings
Rx for cushings
Physiological effects of excess cortisol secretion
Complications post pituitary surgery
Pathophysyology of myotonic dystrophy
Clinical features of myotonic dystrophy
Hx for myotonic dystrophy
Ex for myotonic dystrophy
Ix for myotonic dystrophy
Rx for myotonic dystrophy
DDx of muscle weakness in a male patient
Clinical features and Hx for Duchenne’s Muscular Dystrophy
Ex for Duchenne’s Muscular Dystrophy
Ix for Duchenne’s Muscular Dystrophy
Rx and anaesthetic issues with Duchenne’s Muscular Dystrophy
Clinical features and Hx for ALS
Exam for ALS
ALS severity
ALS Rx and anaesthetic considerations
Guillain Barre Syndrome clinical features and Hx
Guillain Barre Syndrome Exam
Guillain Barre Syndrome Ix and Dx
Guillain Barre Syndrome DDx
Guillain Barre Syndrome Rx and anaesthetic considerations
Indications for Guillain Barre Syndrome intubation
How is plasmapheresis + IV Immunoglobulin administered?
What are the side effects and contraindications?
M&M associated with Guillain Barre Syndrome
DDx motor neuropathy
DDx sensory neuropathy
DDx painful neuropathy
UMN vs LMN lesion
Ex for upper limb neuropathy
Ex for lower limb neuropathy
Clinical features of Multiple Sclerosis
Hx for Multiple Sclerosis?
Ex for Multiple Sclerosis?
Ix and Dx for Multiple Sclerosis
Rx of Multiple Sclerosis
Anaesthetic considerations for Multiple Sclerosis
Clinical features of Myasthenia Gravis
Severity of Myasthenia Gravis
Hx for Myasthenia Gravis
Ex for Myasthenia Gravis
Rx for Myasthenia Gravis
Anaesthetic considerations for Myasthenia Gravis
Give an overview of myasthenic syndrome
Compare Myasthenia Gravis and Myasthenic syndrome
Causes of Parkinsons Disease
Hx for Parkinsons Disease
What are the 4 cardinal signs for Parkinsons Disease on examination?
TRAP
Tremor -resting
Rigidity -cogwheel
Akinesia/bradykinesia -slowness of movement
Postural instability -failure of postural ‘righting’ reflexes leading to poor balance and falls
Parkinsons Disease Rx
Anaesthetic implications of Parkinsons Disease
DDx of symmetrical polyarthropathy
Rheumatoid Arthritis Hx
Rheumatoid Arthritis Ex
Rheumatoid Arthritis Ix and Dx
Rheumatoid Arthritis Rx
Extra-articular manifestations of Rheumatoid Arthritis
Hx for Ankylosing Spondylitis
Ex for Ankylosing Spondylitis
Ix for Ankylosing Spondylitis
Dx for Ankylosing Spondylitis
What is systemic sclerosis
Hx for systemic sclerosis
Ex for systemic sclerosis
Ix for systemic sclerosis
Dx of systemic sclerosis
Rx for systemic sclerosis
Anaesthetic considerations for systemic sclerosis
What is Raynaud’s Phenomenon
Rx and anaesthetic considerations for raynauds
What is SLE
Hx for SLE
Ex for SLE
Ix for SLE
Dx of SLE
Rx for SLE
What is Antiphospholipid Syndrome
Hx marfans
Ex marfans
Ix marfans
Dx marfans
Rx marfans
Marfans anaesthetic considerations
clinical features of elhers danlos syndrome
Ehlers-danlos syndrome considerations
What is sarcoidosis
Hx for Sarcoidosis
Ex for Sarcoidosis
Ix for sarcoidosis
Rx for sarcoidosis
Haemophilia types
Hx and Ex for haemophilia
Ix and severity of haemophilia
Mgmt of haemophilia
What is Chronic Regional Pain Syndrome (CRPS) and its types
Hx for Chronic Regional Pain Syndrome (CRPS)
Ex for Chronic Regional Pain Syndrome (CRPS)
Ix for Chronic Regional Pain Syndrome (CRPS)
Rx and anaesthetic implications for Chronic Regional Pain Syndrome (CRPS)
Hx for Charcot-Marie Tooth
Ix for Charcot-Marie tooth
Ex for Charcot-Marie Tooth
Symptoms of fredrichs ataxia
Granulomatosis with polyangiitis (Wegener granulomatosis) Ex
Hx forGranulomatosis with polyangiitis (Wegener granulomatosis)
