FANZCA Med Viva core Flashcards by Nathan Y

What is aortic sclerosis?

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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 well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is the avg rate of haemodynamic progression in pts diagnosed with AS

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Anaesthesia goals for Aortic Stenosis

How well did you know this?

Not at all

Perfectly

Dynamic manoeuvres to differentiate systolic murmurs

How well did you know this?

Not at all

Perfectly

Causes of Mitral Regurgitation?

How well did you know this?

Not at all

Perfectly

History for Mitral Regurgitation?

How well did you know this?

Not at all

Perfectly

Examination for Mitral Regurgitation

How well did you know this?

Not at all

Perfectly

Severity grading for Mitral Regurgitation

How well did you know this?

Not at all

Perfectly

Stages for Mitral Regurgitation?

How well did you know this?

Not at all

Perfectly

Medical management for Mitral Regurgitation?

How well did you know this?

Not at all

Perfectly

Surgical management of Mitral Regurgitation

How well did you know this?

Not at all

Perfectly

Causes of Mitral Stenosis

How well did you know this?

Not at all

Perfectly

Hx for Mitral Stenosis

How well did you know this?

Not at all

Perfectly

Ex for Mitral Stenosis

How well did you know this?

Not at all

Perfectly

Ix of Mitral Stenosis

How well did you know this?

Not at all

Perfectly

Severity of Mitral Stenosis

How well did you know this?

Not at all

Perfectly

Staging of Mitral Stenosis

How well did you know this?

Not at all

Perfectly

Medical management of Mitral Stenosis

How well did you know this?

Not at all

Perfectly

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