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Clinical Medicine > General Medicine > Flashcards

General Medicine Flashcards

1
Q

Definitions of different ACS

A

Stable angina: Pain with exercise/emotion, relieved by rest, -ve trops, -ve ECG
Unstable angina: Pain at rest/unpredictable, -ve trops, -ve ECG
NSTEMI- positive trops, no ST elevation ECG
STEMI- Positive trops, ST elevation ECG

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2
Q

History to ask for ACS

A

SOCRATES
History of similar pain
Risk factors and risk factor control

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3
Q

Risk factors for ACS

A 
Previous angina
Hyperlipidaemia
DM
HTN
FHx
Smoking
OCP
Obesity
Physical inactivity
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4
Q

OPTICPR for ACS

A

Presentation: Hospital admissions
Ix: ECG/ETT/Echo/Angiogram
Tx: Angioplasty, thrombolysis, grafting (what vessels, how many, what stent type) — Meds started
Complications: Arrythmias, HF, further events

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5
Q

Exams to do for ACS

A 
CVS
BP
Valve disease
HF signs
Rhythm signs
Vitals
If diabetic/HTN- optic fundi for retinal changes
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6
Q

DDx for ACS

A 
GORD
Oesophageal spasm
MSK
PE
Pericarditis
Pneumonia
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7
Q

Ix for ACS

A 
ECG- look for changes
Tn- now and in 6 hours
Bloods- FBC, U/e, TFT, Lipids, HbA1c
CXR
Echo
Angiogram
ETT
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8
Q

Immediate Mx for anginas

A

Stable angina- GNT spray (interacts with sildenafil) +/- B blockers
Unstable- Aspirin, GTN, B blocker, secondary prevention +/- angiogram/angioplasty

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9
Q

Immediate mx for STEMI

A

Morphine, O2 Nitrates, Aspirin, Tigagrelor/clopidogrel, metoclopramide
Admit CCU
PCI if door to balloon in 90 mins- can’t do if prev bypass
Thrombolysis. If <85, IV tenectaplase. If 85+. streptokinase

Long term ACEi and B Blocker

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10
Q

Immediate mx for NSTEMI

A

Morphine, O2 Nitrates, Aspirin, Tigagrelor/clopidogrel, metoclopramide
Admit CCU
Early revascularization up to 24h after

Long term ACEi and B blocker

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11
Q

MI complications

A

Arrytmias
Bradycardias
HF
Further events

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12
Q

Secondary prevention of further ACS events

A

Non-pharmacological

  • Diet, exercise, smoking cessation
  • Cardiac rehab

Parmacological

  • BP lowering- (ACEi)
  • Statins
  • Aspirin forever, Ticagrelor for 12 mos
  • B blocker/Dilt/Nitrates for angina

Surgical
- If 3 vessel disease/LV damage/LCA stenosis/LAD stenosis- CABG

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13
Q

History headings for HF

A 
Symptoms
Precipitants
Risk factors
Investigations
Meds 
Impact on life
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14
Q

Heart failure symptoms

A

Symptoms

  • Left sided: Dyspnoea/poor ETT, fatigue, orthopnoea/PND, nocturnal cough & wheeze, nocturia, cold peripheries
  • Right sided: Peripheral oedema, ascites, nausea and anorexia, facial engorgement, neck pulsation, epistaxis
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15
Q

Precipitants of HF

A
  1. Cardiac
    - Arrythmia
    - MI
    - Valve injury/RF
    - HTN
    - Cardiomyopathy/congenital
    - LHF causing RHF (CCF)
  2. Resp
    - CLD (cor pulmonale)
    - PE
  3. Meds
    - Diuretic cessation
  4. Other
    - Thyrotoxicosis
    - Anaemia
    - Infection and fever
    - Anaesthesia and surgery
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16
Q

Risk factors for HF

A

Coronary artery disease
- HTN, hyperlipidaemia, smoking, DM, obesity, inactivity, CAD, family hx, high alcohol

Dilated cardiomyopathy
- Alcohol intake, FHx, haemochromatosis

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17
Q

Ix for HF

A

Echo, ETT, cardiac catheterisation

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18
Q

Exam for HF

A

CV exam

  • RHF- pitting oedema, JVP, ascites, hepatomegaly
  • LHF- Cyanosis, cool peripheries, lung crackes and stony dullness
  • Both- murmur, anaemia, AF, parasternal heave, cheyne stokes breathing, displaced apex, S3
  • Lying and standing BP
  • Pacemaker
  • Cachexia
  • Resp
  • PVD briefly
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19
Q

NYHA classes

A

I: No symptoms or exercise limitation
II: Mild SOB and slight activity limitation
III: Marked activity limitation even when doing normal daily activities
IV: Symptoms at rest, mostly bedbound

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20
Q

Mx of HF precipitants

A

Manage underlying cause (arrythmia, thombolysis, CABG, med review, thyroid mx, valve replacement, transfusion)

21
Q

Acute HF mx

A 
Sit patient up
Morphine
GTN
Oxygen
Furosemide
22
Q

Mx of chronic HF (non pharm)

A 
Low salt diet
Fluid restriction to 1.5L/day
CV risk control
Flu and pneumococcal vax
Advance care planning
Action plan
23
Q

Pharm Mx of chronic HF

A
  1. Furosemide
    • BB/ACE
    • BB + ACE
    • Spiro
  5. Digoxin + spiro + anticoagulant

Note: Do NOT give CCB/NSAIDs

24
Q

Drugs that improve HF survival

A

ACE
BB
Spiro
ARNi

25
Q

Hx for arrythmias

A 
Palpitations
Assoc sx
Timing
Treatment used
Ix
FHx sudden cardiac death
Prev. cardiac surgery/congenital heart disease
AF precipitants
26
Q

Arryhthmia things to ask about palpitations

A 
Speed and regularity
Fast and irregular?  AF
Fast, regular, asymptomatic? SVT
Fast, regular, symptomatic?  VT
Syncope with brady?  Heart block
27
Q

Arrhythmia things to ask about assoc sx

A 
Dizziness
Sincope
SOB
Stroke Hx
Pain
28
Q

Arrhythmia things to ask about timing

A

Paroxysmal vs permanent

Self resolving vs. requires treatment

29
Q

Arrhythmia things to ask about treatment so far

A

Meds- rate, rhythm control, SE, INR and testing
Electric cardioversion
Physical manoeuvres
Pacemakers/ICD and their impact on QoL

30
Q

Arrythmia things to ask about AF precipitants

A

Demographic: Male, obesity, age
Lifestyle: Smoking, alcohol
Medical: HTN, thyroid, DM, PE, CKD, IHD, OSA
Surgical: Valve disease, cardiac surgery

31
Q

Most common AF precipitants

A

Age, HTN

32
Q

Arrhythmia Exam

A

Cardiovascular- Pulses, scars, devices
Signs of heart failure or valve disease
Recent abdo surgery
Thyrotoxicosis

33
Q

Ix fo arrhythmias

A

ECG- resting (+ holter if symptomatic)
Bloods: U/E, TFTs, trops
Echo- valve disease, cardiomyopathy, hypertrophy, wall size
ETT if sx/known IHD
Electrophysiology study to assess arrhythmia inducibility pre and post management

34
Q

Mx of symptomatic bradycardia

A

Permanent pacemaker if

  1. Complete heart block
  2. 2nd degree AV block
  3. Sinus node dysfunction
35
Q

Mx of VT

A

Haemodynamically stable? (or no response/contraindicated amiodarone)
Yes: Amiodarone
No: ICD

36
Q

Mx of torsades des points

A

MgSO4

37
Q

Mx acute AF

A

Been there for more than 48h?

YES: Rate control- Metoprolol, diltiazem or digoxin
+ Thromboprophylaxis if likely to recur: Dabi firstline or clexane bridging to warfarin

NO: Cardiovert
Haemodynamically stable?
YES: 5mg Amiodarone + 900mg in 23h infusion
NO: DC cardioversion

38
Q

Sx of pneumonia

A 
Fevers
Rigors
Cought +/- sputum
Dyspnoea
Haemoptysis
Malaise
Pleuritic chest pain
39
Q

Pathogens causing different pneumonias

A 
CAP:  Strep pneumoniae, HiB, viral in 15%
HAP:  Normally gram -ves or staph aureus
Aspiration- likely GI organisms
Immunocompromised- any.
HIV- pneumocystitis jiroveci
40
Q

Exam findings in pneumonia

A

Vitals- Tachycardia, tachypnoea, hypotension
Confusion
Fever, cyanosis
Lungs- Consolidation (decreased expansion, dull to percussion, increased tactile fremitus and vocal resonance, bronchial breathing
Pleural rub
Crackles

41
Q

Ix for pneumonia

A 
CXR- shows lobar/multilobar consolidation, effusion, cavitation, air bronchograms
O2 sats and ABG if severe
Bloods:  FBC, U/Es, CRP, cultures
Sputum:  Microscopy, culture, PCR
Urine:  Pneumococcus, legionella
Pleural fluid: Culture if needed
Bronchoscopy and lavage if in ICU
42
Q

What are the CURB 65 score components

A 
Confusion
Urea >7
Resps >30
BP <90 / 60
65+
43
Q

What are the CURB score meanings

A

1: Home management
2: Hospital management
3: Consider ICU

44
Q

Management of CAP

A

ABX- PO if not severe or not vomiting, IV if vomiting or severe
MILD: Amox 500mg tds OR Roxithromycin
Mod: Amox 1g IV Q8h + azithromycin 500mg PO daily. - switch to oral amox at 48h
Severe: Augmentin 1.2g IV Q8h + azithromycin 500mg PO OR erythromycin 500mg IV Q6h
OR cefuroxime 1.5g Q8h + azithromycin 500mg po
OR moxifloxacin

45
Q

Management of HAP

A

Augmntin 1.2g IV Qh8 to orals at 48h

OR cef/moxi as for CAP

46
Q

Management of complex HAP

A

Tazocin or moxi

47
Q

Management of pneumonia other than ABX

A 
Fluids
O2 PRN
Paracetamol for pleurisy
Repeat CXR if no improvement
Pneumococcal vaccine if at risk

F/u CXR at 6/52

48
Q

Complications of pneumonia

A 
Pleural effusion
Empyema
Lung abscess
Resp failure
Septicaemia
Pericarditis

Clinical Medicine (5 decks)

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