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5 Medicine > February > Flashcards

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
Q

Slow rising pule with narrow pulse pressure is a sign of whatr

A

Aortic stenosis

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26
Q

Ejection systolic murmur with no radiation and normal pulse is a sign of what?

A

Aortic sclerosis

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27
Q

Symptoms and signs of infective endocarditis

A

FROM JANE

Fever
Roth spots
Oslers nodes
Murmur

Janeway lesions
Anaemia
Nailbed haemorrhages
Embolus

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28
Q

Types of symptoms and signs in infective endocarditis

A

Systemic - septic picture, weight loss,
Vasculitic - janeway lesions, septic embolus, microvascular haemorrhages,
Immunologic - oslers nodes, roths spots, glomerulonephritis

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29
Q

What bloods can be seen increased in myocarditis?

A

Increased trop, increased CK

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30
Q

What is a cause for J waves and bradycardia?

A

Hypothermia

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31
Q

What drug is contraindicated in aortic stenosis?

A

Nitrates

32
Q

What heart condition is associated with excessive alcohol intake?

A

Dilated cardiomyopathy

33
Q

What condition is associated with electrical alternas

A

Cardiac tamponade

34
Q

NICE guidelines for management of heart failure with reduced ejection fraction?

A

1) ACEi + BB (B1 specific e.g. bisoprolol)
2) Spironolactone or Hydralazine + Nitrate (afrocarribean)
3) Digoxin

Offer furosemide if fluid overload

35
Q

Threshold for treating hypertension?

A

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
Q

What is BNP a marker of?

A

Ventricular heart strain

37
Q

What non-cardiac cause can raise a BNP

A

CKD

38
Q

Why is patent ostium secundum more likely to cause a stroke than a ventricular septal defect

A

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
Q

causes of respiratory alkalosis

A 
initial asthma attack
anxiety
salicilate poisoning
CNS disorders
pulmonary embolism
pregnancy
40
Q

what is the pattern of fibrosis in idiopathic pulmonary fibrosis?

A

usually bilateral lower lobes

41
Q

what conditions predominantly affect lower zones?

A

IPF
SLE
drug induced e.g. methotrexate
asbestosis

42
Q

what zones does coal workers pneumoconiosis predominatly affect?

A

upper zones

43
Q

how to tell difference between ARDS and pulmonary edema with pulmonary capillary wedge pressure?

A

pulmonary edema will show increased pulmonary capillary wedge pressure vs ARDS which shows normal

44
Q

what spirometry picture would be seen in extrinsic allergic alveolitis?

A

restrictive picture

45
Q

eosinophils are raised in hypersensitivity pneumonitis, true or false?

A

false - EEA or HP does not show raised eosinophils

46
Q

what in a patient’s history can point to a diagnosis of rheumatic fever

A

recent sore throat/streptococcal infection 2-6 weeks prior

47
Q

what pH should a NG tube aspirate be?

A

<5.5

48
Q

which lobes would Alpha-1 antitrypsin deficiency manifest with emphysema?

A

lower lobes mostly

49
Q

how to diagnose asthma in >17 year old?

A

FeNO + spirometry reversibility test

50
Q

what type of chorea is found associated with rheumatic fever?

A

sydenham chorea

51
Q

what is meig’s syndrome?

A

ovarian mass + ascites + pleural effusion

52
Q

management for pneumothorax

A

pri pmtx - if >2cm aspirate then consider chest drain

sec pmtx - if over 50 and >2cm = chest drain, if not aspirate

53
Q

what drug is the most common cause of drug induced angioedema?

A

ACEi

54
Q

what is Beck’s triad?

A

cardiac tamponande

hypotensive
raised jvp
muffled heart sounds

55
Q

which type of lung cancer is most associated with gynaecomastia?

A

adenocarcinoma

56
Q

what kind of neuropathy can diabetes cause?

A

autonomic and sensory

57
Q

what does bendroflumethiazide do to serum calcium levels?

A

hypercalcaemia

58
Q

common cancers causing lung mets

A

before computer people read books

breast
colorectal
prostate
renal
bladder
59
Q

Which diuretic can cause osteoporosis ?

A

Loop diuretics - furosemide

60
Q

In t1dm, what to do with insulin when ill?

A

Increase

61
Q

when to stop insulin iv infusion during DKA episode?

A

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
Q

Why antibodies are present in autoimmune thyroiditis?

A

Hypo - anti TPO

Hyper - TRab

63
Q

What thyroid condition presents with a painful goitre?

A

De Quervains thyroiditis

64
Q

what is secondary hyperparathyroidism?

A

Vit D deficiency

65
Q

What do Ca, PTH, ALP, phos look like in secondary hypeparathyroidism ?

A

Low ca, high pth, high alp, high phosphate

66
Q

What do Ca, PTH, ALP, Phos look like in primary hypeparathyroidism ?

A

High ca, high or inappropriately normal PTH, low ALP, low phos

67
Q

How to investigate cushings syndrome?

A

24 hr urinary cortisol
Serum/salivary cortisol at midnight and morning
Dexamethasone suppresion
Imaging

68
Q

Explain dexethasone supp tests

A

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
Q

2 causes of primary hyperaldosteronism

A

Adrenal hyperplasia

Conns syndrome = adrenocortical adenoma

70
Q

Symptoms of hyperaldosteronism

A

Low K+, high Na, high BP,

71
Q

How to interprete aldosterone:renin ratios?

A

If high aldos:renin ratio = primary hyperaldosteronism

If normal aldos:renin = secondary hyperaldosteronism

72
Q

What causes secondary hyperaldosteronism

A

Reduced renal perfusion causing high renin secretion

73
Q

How to treat hyperplasia hyperaldosteronism

A

Spironolactone

74
Q

what diabetes and treatment is associated with HNF1-alpha mutation?

A

MODY1 - use sulphonylurea

75
Q

what diuretic can cause gynaecomastia?

A

spironolactone

5 Medicine (5 decks)

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