From Questions Flashcards
Specific MoA of Salbutamol
Stimulates B2 receptors of respiratory tract, which increases sympathetic activity and relaxes bronchial smooth muscle
Signs on examination of consolidation?
- Reduced chest expansion
- Dull percussion note
- Increased tactile fremitus
- Increased vocal fremitus
- Bronchial breathing
Percussion note in:
- consolidation
- pleural effusion
- pneumothorax
Consolidation = dull
Pleural effusion = Stony dull
Pneumothorax = hyperresonant
Why are TB cases increased?
- HIV/AIDs
- Use of immunosuppressive drugs
- Poor socio-economic conditions and overcrowding
- Increased immigration from areas of high prevalence of TB
- Multidrug resistance
Why do we use 4 drugs to treat TB?
To combat multidrug resistance
Causes of erythema nodosum?
- Idiopathic
- Crohn’s, UC
- Sarcoidosis
- Drugs (oral contraceptive, sulphonamides)
- Streptococcal infection
- Chlamydia
Bronchiectasis
Complications
- Pneumonia
- Septicaemia
- Recurrent pneumonia/LRTIs
- Haemoptysis
- Respiratory failure
- Cor pulmonale
- Pneumothorax
Common places for lung cancer to metastasize to?
- Brain
- Bone
- Liver
- Adrenals
- Other sites on the lungs
What test would you do to look for superior vena cava syndrome?
Pemberton’s sign (lift hands above head and keep them there for a minute)
CXR signs in idiopathic pulmonary fibrosis?
- Reduced lung vol
- Reticulonodular shadowing - often worse in lower zones
- Honeycomb lung - advanced disease
Causes of clubbing
- bronchial carcinoma
- mesothelioma
- bronchiectasis
- cryptogenic organising pneumonia
- chronic empyema
- chronic lung abscess
Causes of bilateral hilar lymphadenopathy
- Lymphoma
- Bronchial carcinoma
- TB
- Mycoplasma
- Extrinsic allergic alveolitis
Biopsy in sarcoidosis?
Non-caseating granulomas
Extraplumonary manifestations of sarcoidosis?
- Erythema nodosum
- Anterior uveitis
- Posterior uveitis
- Arthralgia
- Bone cysts
- Neuropathy
- Cranial nerve palsies
- Cardiomyopathy
- Lymphadenopathy
- Hepatosplenomegaly
- Hypercalcaemia
Drugs used for pleurodesis
- Talc
- Bleomycin
- Tetracycline
Aspiration pneumonia
RFs
- Poor dental hygiene
- Swallowing difficulties
- Prolonged hospitalization or surgical procedures
- Impaired consciousness
- Impaired mucociliary clearance
Aspiration pneumonia
Which lobes are most commonly affected?
Right middle and lower lung lobes are the most common sites affected, due to the larger calibre and more vertical orientation of the right main bronchu
Aspiration pneumonia
Aerobic bacteria examples
Streptococcus pneumoniae Staphylococcus aureus Haemophilus influenzae Pseudomonas aeruginosa Klebsiella: often seen in aspiration lobar pneumonia in alcoholics
Aspiration pneumonia
Anaerobic bacteria examples
Bacteroides
Prevotella
Fusobacterium
Peptostreptococcus
How does a posterior MI present?
Changes in V1-3
Reciprocal changes of STEMI are typically seen:
- horizontal ST depression
- tall, broad R waves
- upright T waves
- dominant R wave in V2
Posterior infarction is confirmed by ST elevation and Q waves in posterior leads (V7-9)
3rd heart sound
What does it represent?
When is this normal?
What pathologies could it indicate?
- Caused by diastolic filling of the ventricle
- Considered normal if < 30 years old (may persist in women up to 50 years old)
- Heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation
Side effects of adenosine?
- Transient feeling of warmth/flushing
- Chest pain
- Bronchospasm
- Can enhance conduction down accessory pathways, resulting in increased ventricular rate (e.g. WPW syndrome)
Adenosine
What enhances it’s effect?
What blocks the effect?
- The effects of adenosine are enhanced by dipyridamole (antiplatelet agent)
- Blocked by theophyllines
Adenosine
When should it be avoided?
It should be avoided in asthmatics due to possible bronchospasm.
Adenosine
MoA
- Causes transient heart block in the AV node
- Agonist of the A1 receptor in the atrioventricular node, which inhibits adenylyl cyclase thus reducing cAMP and causing hyperpolarization by increasing outward potassium flux
- Adenosine has a very short half-life of about 8-10 seconds
Changes to ECG in few days following STEMI?
- T wave inversion
- Pathological Q waves
Complications of coronary angiography?
- Bleeding/hemorrhage
- Infection
- MI
- Stroke
- Allergy to contrast
- Damage to coronary vessels, requiring intervention
,- Death
Angina
Other than exertion, what may trigger it?
- Cold/windy weather
- Emotion
- Lying down
- Vivid dreams
Angina
How does aspirin help prevent coronary events?
- Irreversibly inhibits cyclooxygenase, which prevents further production of TxA2 (thromboxine) from platelets as they do not have a nucleus, shifting the balance of PGI2: TxA2 towards inhibiting platelet aggregation
Acute pulmonary oedema management
- Furosemide
- GTN/nitrates
- Morphine
- Oxygen
What is a capture beat?
A normal QRS complex between VT complexes
What ECG changes can digoxin cause?
ST depression
T wave inversion
In leads V5-V6
Where and how does furosemide work?
Loop of Henle, ascending limb !!
Competitively inhibits the Na-K-2Cl cotransporter in the thick ascending limb of Loop of Henle, diminishing the osmotic gradient for water absorption
BNP in HF
- If high (> 2000 NTproBNP or > 400 BNP): ECHO and specialist assessment within 2 weeks
- If raised (> 400 NTproBNP or >100 BNP): ECHO and specialist assessment within 6 weeks
How to calculate BMI?
Weight divided by Height squared
BMI classifications
Underweight: < 18.5
Normal: 18.5 - 24.9
Overweight: 25 - 30
Obese: > 30
Statin MoA
Inhibits HMG-CoA reductase, the rate-limiting step in cholesterol synthesis
Causes of AF
Pneumonia MI PE Hyperthyroidism Alcohol excess Heart failure Endocarditis Mitral stenosis
Hypercalcaemia ECG changes
- SHORT QT INTERVAL
- In severe hypercalcaemia, Osborn waves (J waves) may be seen
- Ventricular irritability and VF arrest has been reported with extreme hypercalcaemia
Metabolic causes of seizures
Hypoglycemia Hyponatraemia Hypernatraemia Anoxia Water intoxification
Which airway would you consider in a seizure?
Nasopharyngeal
3 layers of the meninges
- Dura mater
- Arachnoid mater
- Pia mater
Muscles in hand/wrist supplied by median nerve?
LLOAF
- Two lateral lumbricals
- Opponens pollicis
- Abductor pollicis brevis
- Flexor pollicis brevis
Rfs for carpal tunnel
idiopathic pregnancy oedema e.g. heart failure lunate fracture rheumatoid arthritis
Ix’s for carpal tunnels
Electrophysiology
motor + sensory: prolongation of the action potential
Tx of carpal tunnel
corticosteroid injection wrist splints at night surgical decompression (flexor retinaculum division)
What anatomical landmark allows categorisation of upper/lower GI bleed during endoscopy?
The ligament of Treitz at the duodenojejunal flexure
What is budd chiari syndrome
Budd-Chiari syndrome, or hepatic vein thrombosis, is usually seen in the context of underlying haematological disease or another procoagulant condition
- polycythaemia rubra vera
- thrombophilas
- pregnancy
- COCP
Features of budd chiari
abdominal pain: sudden onset, severe
ascites → abdominal distension
tender hepatomegaly
Budd chiari
Ix’s
- US with doppler flow studies
Criteria for liver transplant in paracetamol overdose
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
- prothrombin time > 100 seconds
- creatinine > 300 µmol/l
- grade III or IV encephalopathy
