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February Flashcards

1
Q

What kind of MI can cause bradycardia? Why?

A

Inferior MI - RCA - supplies SA node

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2
Q

Broad causes of bradycardia

A 
Drugs
Conductive (blood supply or structural)
Structural (infection, infiltrates)
Neural (vagal, increased ICP)
Endocrine/homeostasis (hypothyroid, hypokalaemia, hypothermia)
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3
Q

Drugs that can cause bradycardia?

A

Antiarrythmics (amiodarone)
Beta blockers
CCB (verapamil)
Digoxin

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4
Q

Medical treatment options for profound bradycardia ?

A

Atropine up to 3g IV

Isoprenaline

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5
Q

Main important differential to identify in narrow complex tachycardia?

A

AF or not AF

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6
Q

Treatment options in acute tachy AF

A

Rate control - metoprolol or digoxin
If <48h - DC cardioversion, or amiodarone

Consider anticoagulation with heparin pr warfarom

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7
Q

3 rhythms described as broad complex tachys

A

Ventricular tachycardia
Torsade de pointe
SVT with BBB

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8
Q

What happens to QT interval in hypokalaemia?

A

Increased QTI

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9
Q

What electrolyte imbalance can cause VT?

A

Hypokalaemia and hypomagnesaemia

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10
Q

Causes of ventricular tachycardia

A

IM QVICK

infarction
Myocarditis

QT interval increase
Valve disease - AS, MR
Iatrogenic - digoxin, antiarrythmics, catheter
Cardiomyopathy
K low, Mg low, O2 low, acidosis
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11
Q

3 scenarios in AF

A

Acute <48 hrs
Paroxysmal
Persistent

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12
Q

Management of acute AF

A

Haemodynamically unstable = DC cardiovert

Otherwise - rate control with verapamil or diltiazem, or digoxin/amiodarone

Rhythm control with flecainide or amiodarone

Chadvasc score

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13
Q

Management of paroxysmal AF

A

Pill in pocket

Long term bb

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14
Q

Management of persistent AF

A

Anticoagulate for 3 weeks at least, then cardiovert DC or medical

Or rate control with BB or rate limiting CCB

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15
Q

What does a new onset LBBB also imply?

A

STEMI

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16
Q

Which coronary artery is implicated in STEMI seen in V2 3 4

A

Left anterior descending - anterioseptal

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17
Q

What should you consider if ST depression is seen in V 1 2 3?

A

Posterior STEMI

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18
Q

58 year old man presenting with chest pain. ECG shows sinus tachy with TWI.

Hx shows STEMI 1 week ago.

O/E mildy pyrexic, pain is relieved by sitting forward

What is the most likely diagnosis and what investigation needs to be done

A

Pericarditis

ECHO

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19
Q

In STEMI, if patient is not given PCI or thrombolysis, what should the patient be prescribed?

A

LMWH

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20
Q

Management of STEMI

A 
ABCDE assessment
O2, IV access
Aspirin 300mg, clopidogrel 300mg PO
Morphine 5-10mg IV, metoclopramide 10mg IV
GTN, betablocker IV
LMWH
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21
Q

Normal ejection fraction see on ECHO?

A

60%

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22
Q

Key investigation in heart failure

A

ECHO

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23
Q

Secondary causes of hypertension

A 
PREDICTION
P = primary 95%
R = renal (renal artery stenosis, GNtis, APKD)
Endocrine = cushings, phaeochromcytoma, conns, hyperthyroid, acromegaly
Drugs = cocaine, NSAIDs, COCP
ICP = increased ICP (cushings reflex)
Coarctation of aorta
Toxaemia of pregnancy
Increased viscosity
Overloaded with fluid
Neurogenic causes
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24
Q

End organ damage due to hypertension

A

CANER

Cardiac - LVF, AR, MR, IHD
Aortic - dissection, aneurysm 
Neuro - stroke, encephlopathy from malignant htn
Eyes - hypertensive retinopathy
Renal - proteinuria, CKD
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25
Slow rising pule with narrow pulse pressure is a sign of whatr
Aortic stenosis
26
Ejection systolic murmur with no radiation and normal pulse is a sign of what?
Aortic sclerosis
27
Symptoms and signs of infective endocarditis
FROM JANE Fever Roth spots Oslers nodes Murmur Janeway lesions Anaemia Nailbed haemorrhages Embolus
28
Types of symptoms and signs in infective endocarditis
Systemic - septic picture, weight loss, Vasculitic - janeway lesions, septic embolus, microvascular haemorrhages, Immunologic - oslers nodes, roths spots, glomerulonephritis
29
What bloods can be seen increased in myocarditis?
Increased trop, increased CK
30
What is a cause for J waves and bradycardia?
Hypothermia
31
What drug is contraindicated in aortic stenosis?
Nitrates
32
What heart condition is associated with excessive alcohol intake?
Dilated cardiomyopathy
33
What condition is associated with electrical alternas
Cardiac tamponade
34
NICE guidelines for management of heart failure with reduced ejection fraction?
1) ACEi + BB (B1 specific e.g. bisoprolol) 2) Spironolactone or Hydralazine + Nitrate (afrocarribean) 3) Digoxin Offer furosemide if fluid overload
35
Threshold for treating hypertension?
Clinic BP > 140 offer APBM/HBPM If home <135 average, monitor If ≥135 AND <80 y/o treat IF end organ damage, renal disease, diabetes, established cardiovascular disease, qrisk score≥10% If ≥ 150 treat If clinic BP ≥ 180 treat
36
What is BNP a marker of?
Ventricular heart strain
37
What non-cardiac cause can raise a BNP
CKD
38
Why is patent ostium secundum more likely to cause a stroke than a ventricular septal defect
Cos higher pressure in right atrium causing right to left shunting. Compared to ventricles where left ventricle is higher pressure causing left to right shunting
39
causes of respiratory alkalosis
``` initial asthma attack anxiety salicilate poisoning CNS disorders pulmonary embolism pregnancy ```
40
what is the pattern of fibrosis in idiopathic pulmonary fibrosis?
usually bilateral lower lobes
41
what conditions predominantly affect lower zones?
IPF SLE drug induced e.g. methotrexate asbestosis
42
what zones does coal workers pneumoconiosis predominatly affect?
upper zones
43
how to tell difference between ARDS and pulmonary edema with pulmonary capillary wedge pressure?
pulmonary edema will show increased pulmonary capillary wedge pressure vs ARDS which shows normal
44
what spirometry picture would be seen in extrinsic allergic alveolitis?
restrictive picture
45
eosinophils are raised in hypersensitivity pneumonitis, true or false?
false - EEA or HP does not show raised eosinophils
46
what in a patient's history can point to a diagnosis of rheumatic fever
recent sore throat/streptococcal infection 2-6 weeks prior
47
what pH should a NG tube aspirate be?
<5.5
48
which lobes would Alpha-1 antitrypsin deficiency manifest with emphysema?
lower lobes mostly
49
how to diagnose asthma in >17 year old?
FeNO + spirometry reversibility test
50
what type of chorea is found associated with rheumatic fever?
sydenham chorea
51
what is meig's syndrome?
ovarian mass + ascites + pleural effusion
52
management for pneumothorax
pri pmtx - if >2cm aspirate then consider chest drain sec pmtx - if over 50 and >2cm = chest drain, if not aspirate
53
what drug is the most common cause of drug induced angioedema?
ACEi
54
what is Beck's triad?
cardiac tamponande hypotensive raised jvp muffled heart sounds
55
which type of lung cancer is most associated with gynaecomastia?
adenocarcinoma
56
what kind of neuropathy can diabetes cause?
autonomic and sensory
57
what does bendroflumethiazide do to serum calcium levels?
hypercalcaemia
58
common cancers causing lung mets
before computer people read books ``` breast colorectal prostate renal bladder ```
59
Which diuretic can cause osteoporosis ?
Loop diuretics - furosemide
60
In t1dm, what to do with insulin when ill?
Increase
61
when to stop insulin iv infusion during DKA episode?
After patient eating normally, long acting insulin night before, then short acting insulin morning during breakfast, stop IVI 30 mins after short acting insulin
62
Why antibodies are present in autoimmune thyroiditis?
Hypo - anti TPO | Hyper - TRab
63
What thyroid condition presents with a painful goitre?
De Quervains thyroiditis
64
what is secondary hyperparathyroidism?
Vit D deficiency
65
What do Ca, PTH, ALP, phos look like in secondary hypeparathyroidism ?
Low ca, high pth, high alp, high phosphate
66
What do Ca, PTH, ALP, Phos look like in primary hypeparathyroidism ?
High ca, high or inappropriately normal PTH, low ALP, low phos
67
How to investigate cushings syndrome?
24 hr urinary cortisol Serum/salivary cortisol at midnight and morning Dexamethasone suppresion Imaging
68
Explain dexethasone supp tests
If not supressed after low dose = cushings syndrome After high dose look at ACTH and cortisol If ACTH low, cortisol low = ACTH producing pituitary adenoma If ACTH high, cortisol high = ACTH producing exogenous tumour If ACTH low, cortisol high = cortisol producing tumor
69
2 causes of primary hyperaldosteronism
Adrenal hyperplasia | Conns syndrome = adrenocortical adenoma
70
Symptoms of hyperaldosteronism
Low K+, high Na, high BP,
71
How to interprete aldosterone:renin ratios?
If high aldos:renin ratio = primary hyperaldosteronism If normal aldos:renin = secondary hyperaldosteronism
72
What causes secondary hyperaldosteronism
Reduced renal perfusion causing high renin secretion
73
How to treat hyperplasia hyperaldosteronism
Spironolactone
74
what diabetes and treatment is associated with HNF1-alpha mutation?
MODY1 - use sulphonylurea
75
what diuretic can cause gynaecomastia?
spironolactone

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