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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
Hx for arrythmias
``` Palpitations Assoc sx Timing Treatment used Ix FHx sudden cardiac death Prev. cardiac surgery/congenital heart disease AF precipitants ```
26
Arryhthmia things to ask about palpitations
``` Speed and regularity Fast and irregular? AF Fast, regular, asymptomatic? SVT Fast, regular, symptomatic? VT Syncope with brady? Heart block ```
27
Arrhythmia things to ask about assoc sx
``` Dizziness Sincope SOB Stroke Hx Pain ```
28
Arrhythmia things to ask about timing
Paroxysmal vs permanent | Self resolving vs. requires treatment
29
Arrhythmia things to ask about treatment so far
Meds- rate, rhythm control, SE, INR and testing Electric cardioversion Physical manoeuvres Pacemakers/ICD and their impact on QoL
30
Arrythmia things to ask about AF precipitants
Demographic: Male, obesity, age Lifestyle: Smoking, alcohol Medical: HTN, thyroid, DM, PE, CKD, IHD, OSA Surgical: Valve disease, cardiac surgery
31
Most common AF precipitants
Age, HTN
32
Arrhythmia Exam
Cardiovascular- Pulses, scars, devices Signs of heart failure or valve disease Recent abdo surgery Thyrotoxicosis
33
Ix fo arrhythmias
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
Mx of symptomatic bradycardia
Permanent pacemaker if 1. Complete heart block 2. 2nd degree AV block 3. Sinus node dysfunction
35
Mx of VT
Haemodynamically stable? (or no response/contraindicated amiodarone) Yes: Amiodarone No: ICD
36
Mx of torsades des points
MgSO4
37
Mx acute AF
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
Sx of pneumonia
``` Fevers Rigors Cought +/- sputum Dyspnoea Haemoptysis Malaise Pleuritic chest pain ```
39
Pathogens causing different pneumonias
``` CAP: Strep pneumoniae, HiB, viral in 15% HAP: Normally gram -ves or staph aureus Aspiration- likely GI organisms Immunocompromised- any. HIV- pneumocystitis jiroveci ```
40
Exam findings in pneumonia
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
Ix for pneumonia
``` 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
What are the CURB 65 score components
``` Confusion Urea >7 Resps >30 BP <90 / 60 65+ ```
43
What are the CURB score meanings
1: Home management 2: Hospital management 3: Consider ICU
44
Management of CAP
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
Management of HAP
Augmntin 1.2g IV Qh8 to orals at 48h | OR cef/moxi as for CAP
46
Management of complex HAP
Tazocin or moxi
47
Management of pneumonia other than ABX
``` Fluids O2 PRN Paracetamol for pleurisy Repeat CXR if no improvement Pneumococcal vaccine if at risk ``` F/u CXR at 6/52
48
Complications of pneumonia
``` Pleural effusion Empyema Lung abscess Resp failure Septicaemia Pericarditis ```

Clinical Medicine (5 decks)

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