HBP Flashcards
Noradrenaline
hormone and neurotransmitter - mobilises brain and body for action. Increases heart rate and BP, triggers release of glucose from energy stores, increases blood flow to skeletal muscle, reduces blood flow to the GI system and decreases urination and GI motility.
Carcionoid Syndrome
paraneoplastic syndrome occurring secondary to carcinoid tumours. - occurs when serotonin from the carcionoid tumour enters the systemic circulation without hepatic degradation Symps/signs: - Flushing - Diarrhea - Abdo pain - Bronchoconstriction - Restrictive cardiomyopathy - Nausea and vomiting
Carcionoid Tumours
Slow-growing neuroendocrine tumour
- Commonly ass/w/ small bowel
- Secrete excessive levels of hormones mostly serotonin causing flushing, diarrhea, wheezing, abdo cramping, peripheral oedema
- Surgery only curative option (if no mets)
Pleural Effusion
excess fluid accumulating in the pleural space - the fluid-filled space that surrounds the lungs.
Types include: hydrothorax (serous fluid), haemothorax (blood), urinothorax (urine), chylothorax (chyle) and pyothorax (pus) - also called a plural empyema.
Pleural Effusion: Types
Transudate: fluid is pushed through the capillary due to high pressure within the capillary
Exudate: escapes into the pleural cavity by lesions in the blood and lymph vessels (ie. inflammation and tumours)
Conditions ass/w/ Transudate Pleural Effusions
- Congestive heart failure
- Liver cirrhosis
- Severe hypoalbuminaemia
- Nephrotic syndrome
- Acute atelectasis
- Myxedema
- Peritoneal dialysis
- Meig’s syndrome
- End stage kidney disease
Conditions ass/w/ Exudative Pleural Effusions
Additional tests to determine cause: amylase, glucose, pH and cell counts
- Bacterial pneumonia (low glucose)
- Malignancy (↑ amylase)
- Infection
- Trauma
- Pulmonary embolism
- Autoimmune
- Pancreatitis
- Rheumatoid pleurisy (low glucose)
- Drug-induced lupus
Acute Respiratory Distress Syndrome
Type of respiratory failure characterised by rapid onset f widespread inflammation in the lungs.
Symps: SOB/rapid breathing/blueish skin colour
Causes: sepsis/pancreatitis/trauma/pneumonia/aspiration
Tx: Ventilation
Vasculitis
Group of conditions characterised by inflammation of the blood vessel walls Conditions include: - Takayasu's arteritis - Buergers disease - Giant cell arteritis - Polyarteritis nodosa - Wegners granulomatosis Tx: Immunosuppression
Multiple Myeloma
Haematological malignancy characterised by plasma cell proliferation. Genetic mutations when b-lymphocytes differentiate into mature plasma cells.
Multiple Myeloma: Presentation
Usual age 70 years.
CRAB:
- Calcium: hypercalcaemia (↑osteocalsts activity in bones leads to constipation, nausea, anorexia and confusion)
- Renal failure:
Hyperkalaemia Management
- 10 units of actrapid plus glucose (pushes K+ into the cells)
- Calcium Gluconate - stabilize the cardiac memebrane to stop arrhythmias
- Neb salbutamol
- Calcium resonium
Types of Respiratory Failure
Type 1: Low oxygen and low/normal CO2 (Disease which damage the lung tissue - Pulmonary oedema/pneumonia/acute respiratory distress syndrome) - fast/normal breathing
Type 2: Low oxygen and high CO2 (COPD/Chest wall deformities/respiratory muscle weakness/respiratory depression) - slow/shallow breathing
Ludwig’s angina
Severe cellulitis affecting the floor of the mouth. Often caused by a dental infection
Anaphylaxis Management
IM Adrenaline 1:1000 0.5mL
- Make sure patient in bed
- Remove any possible trigger
- Wait 5 mins and then if no effect give adrenaline again
- After repeated doses still no effect then give IV
Chloramephenamine (antihistamine)
Hydrocortisone
Anapylaxis Clinical Signs
Systemic hypersensitivity reaction
- Obsruction of airway/wheeze (can give neb salbutamol)
- Vasodilatation (hypotension/shock/tachy)
- Urticarial rash
- GI upset (GI oedema/diarrhoea can be main presenting symptom)
Anaphylaxis Investigations
Mast cell tryptase 1-2 hours after symptoms and then again when well and compare
F/U: Epi penx2; Antihistamine and steroids for 3 days; Usually keep in hospital overnight; May F/U in allergy clinic
Pulmonary Embolism: Risk Factors
- Recent surgery
- Recent fractures
- Recent immobility
- Personal/FHx of clotting disorder/PE/DVT
- Obesity
- Malignancy
- Infection
- Pregnancy
- COCP/HRT
Pulmonary Embolism: Symptoms
- Shortness of breath
- Plueritic chest pain (on inspiration)
- Cough
- Haemoptysis (from infarcted lung tissue)
- Dizziness/syncope
Pulmonary Embolism: Signs
- Tachypnoea (>20 breaths/min)
- Tachycardia (>100bpm)
- Hypotension (R ventricular strain/raised JVP also indicates this)
- Red, swollen calf
- Pleural rub - could indicate presence of pleural effusion
- Cyanosis
Pulmonary Embolism: Investigations
NICE Guidelines: Calculate probability with a Well’s score
Well’s score>4 (PE likely) - CTPA indicated (any delay in getting start treatment dose anticoagulants/LMWH)
Well’s score 4 or less - D-dimer can rule out PE
VQ scan for patients where CTPA contraindicated (ie renal impairment, contrast allergy, pregnancy)
Reversible Causes of Cardiac Arrest (4 H’s and 4 T’s)
Hypovolaemia (shock/perfusion) Hypothermia (Bair hugger) Hyperkalaemia (aggressive fluid resus to correct electrolytes) Hypoxia (maintain airway) Thrombosis Tension pneumothorax Toxins Tamponade
Benign Prostatic Hyperplasia (BPH)
Increase in prostate size due to failure of apoptosis
Symps:
- Increased frequency
- Urgency
- Hesitancy
- Incomplete bladder emptying
IPSS - Internation Prostate Symptom Score - determines how much symptoms impact on QoL
Tx: alpha-blockers (tamsulosin/doxazosin) or 5-alpha-reductase inhibitor (finasteride) - NB may take awhile to work!
Prostate Cancer
Screening: PSA
Ix: Urinalysis; Renal function tests; Biopsy; MRI; Bone scans if ?mets
Gleason score: prognostic indicator
Tx: Watch and wait; Surgery; Radiotherapy; Chemo; Anti-androgen therapy
Haematuria Causes
- Infection (cystitis, prostatitis, urethritis)
- Tumour (renal cancer, Wilms’ tumour, bladder, prostate, urethral cancer)
- Trauma
- Inflammation (glomerulonephritis)
- Structural (calculi, cysts)
- Haematological (sickle cell)
Atrial Fibrillation
Irregularly irregular ventricular pulse leading to:
- stagnation of blood in the atria - thrombus formation (↑risk embolism and stroke)
- Reduction in cardiac output > heart failure
Ass/ w/ coronary heart disease/hypertension/valvular heart disease/hyperthyroidism
Atrial Fibrillation: Presentation
- Breathless/dyspnoea
- Palpitations
- Syncope/dizziness
- Chest discomfort
- Stroke/TIA
Atrial Fibrillation: Investigations
- ECG
- Bloods: TFTs, FBC (anaemia may cause heart failure), U&E’s, LFTs and coag screen (pre-warfarin)
- CXR
- ECHO
- CT/MRI (any suggestion of stroke)
Upper Motor Neurone Signs
Hypertonia Weakness Paralysis Hyperreflexia Spasticity Positive Babinski sign (toes point upwards) Clonus
Lower motor neurone signs
Hyporelfexia Hypotonia Muscle weakness/paralysis Fasiculations Muscle atrophy
Rebound Tenderness
Indicates peritoneal inflammation
Marker of severity - if + more severe
Wernicke’s Encephalopathy
Vitamin B1 (Thiamine) deficiency
Triad of encephalopathy, gait ataxia and nystagmus
Tx: Pabrinex (contains thiamine)
Alcohol Withdrawal Tx
- Pabrinex (Thiamine complex)
- Fluids to correct dehydration/electrolyte imbalance
- Chlordiazepoxide (sedative benzo; less addictive than other benzos)
Korsakoff’s syndrome
Longer term complication of WE –> nonreversible
- loss of short term memory
- confabulation
- lack of insight
- retrograde amnesia
- apathy
- lack of insight
Delirium Tremens
Fever, marked tremor, tachycardia, agitation and hallucinations, hyperthermia, severe agitation, diaphoresis
Tx: IV Pabrinex; Fluids to correct dehydration/electrolyte imbalance (hypoPhos/Mg); Chlordiazedpoxide
Alpha1-antitrypsin
Early onset COPD and cirrhosis
Budd-Chiari
Clots in the portal hypertension - leads to liver necrosis
Hepatic Encephalopathy
Personality change, intellectual impairment, decreased consciousness
Tx: Laxatives, Rifampicin (to reduce ammonia), NG feeding
- Exclude intracranial pathology
Child-Pugh Classification of Cirrhosis
Uses bilirubin, albumin, PT time, ascites and hepatic encephalopathy
- Used to assess severity, Tx, eligible for transplant
Pancreatitis
Use Glasgow score - LDH
Surgical Sieve
VITAMIN C, D: Vascular Infection/Inflammatory Trauma Autoimmune Metabolic Idiopathic Neoplastic Congenital Degenerative
Anaphylaxis
Tx: IM adrenaline 1:1000 0.5mL - no effect give again in 5mins; Chlorphenamine 10mg IM/Hydrocortisone 100-300mg IV
Ix: Mast Cell Tryptase 1-2 hrs after symps then again when well
F/U: Epi Penx2; antihistamine/steroids for 3 days
Pulmonary Embolism
Resp Alkalosis; Wells score
Tx: O2 and LMWH treatment dose
Ix: VQ scan - CTPA
Diabetic Ketoacidosis (DKA)
Hyperglyceamia, Ketonaemia and Acidosis
- BM>11 mmol/L
- Ketones>3mmol/L
- Acidosis (pH<7.3/Bicarb<15mmol/L)
Ass/w/Type 1 DM
Precipitated by infection, stopping insulin, cardio disease, meds (steroids, thiazides, SGLT2 inhibs), physiological stress
Diabetic Ketoacidosis (DKA) Signs and Symps
- Dehydrated
- Breath smells of ketones (pear-drops/nail polish remover)
- Compensating for the metabolic acidosis - Kussmaul breathing
- Abdo pain/D&V
Diabetic Ketoacidosis (DKA) Ix
- Bedside: BM, Urine dip, ECG
- Bloods: FBC (may have ↑ WCC), U&E’s (↑Na/K+, ↑Urea/Creatinine), ABG (Metabolic acidosis), CRP (possible rhabdomyolysis), Blood cultures, Cardiac enzymes (troponin if MI suspected), amylase (if pancreatitis suspected)
- Other: CXR, Abdo XR, CT Head (if focal neurology), LP (if meningitis suspected - may be precipitant)
- Calculate ion gap
Diabetic Ketoacidosis (DKA) Tx
- Obs and resus
- Large bore cannula IV access
- Catheterisation to monitor urine output
- Fluids 0.9% NaCl +potassium chloride (unless anuria)
- IV Insulin Infusion mix with 0.9% NaCl → concentration of 1unit/mL → infuse at rate of 0.1units/kg/hr
- Continue long-acting insulins
- Monitor ketones and BM hourly → after BM<14mmol/L then glucose 10%IV
Reversible Causes of Cardiac Arrest (4H’s and 4T’s)
- Hypovolaemia
- Hypothermia
- Hyperkalaemia
- Hypoxia
- Thrombosis
- Tension pneumothorax
- Toxins
- Tamponade
Infective Endocarditis
Risk Factors: Prev endocarditis, Rhemumatic Heart disease (strep pyogenes), IVDU
Causes: Strep viridans/Strep aureus
Dx using Modified Duke criteria
Heart Failure Investigations
Bedside: Urinalysis, Peak Flow or Spirometry
Bloods: FBC, U&Es, creatinine, TFTs, LFTs, glucose, lipids, natriuretic peptides** (BNP)
Special: ECG*, CXR then Echo (if findings abnormal from other investigations)
Heart Failure Pharmacological Tx
Diuretics (loop/thiazide) + ACEI (or ARB) + Beta Blocker
Mitral Stenosis
commonly caused by Rheumatic fever
Mid-diastolic murmur
Ass/w/ Malar flush, AF and L parasternal heave
Mitral Regurgitation
commonly caused by mitral valve prolapse
Aortic Stenosis
Commonest valve lesion - degenerative calcific leading to compensatory LVH
- triad of dyspnoea, angina and syncope
- radiates to carotids
Ix: Dobutamine stress test
Aortic Regurgitation
Rheumatic heart disease, aortic root disease (Marfan’s, aortic dissection)
- collapsing pulse
Atrial Fibrillation Ix
Ix: ECG, ECHO and TOE, CXR
Bloods: Thyroid function (thyrotoxicosis may present as AF), Troponin/cardiac enzymes, drug levels (esp digoxin), ABGs (hypoxia, shock, acidosis)
Atrial Fibrillation Tx
Emergency (haemodynamically unstable) - pharmacological cardioversion w/flecainide or amiodarone (LV impairment)
Rate control: Beta blockers/calcium channel blockers (verapamil/diltiazem)/digoxin (2nd line)
Rhythm control: Flecainide, amiodarone
Surgical ablation
Atrial Fibrillation Anti-coagulation
CHADS2 score >= 2 then warfarin
Lower risk = aspirin/clopidogrel
Long QT Syndrome
Autosomal dominant condition –> prolonged QT interval - predisposed to ventricular arrhythmias, syncope and SCD
- can acquire long QT from drugs, low K+, Mg and Calcium or severe bradycardia
Mx: Avoid triggers (sympathetic activity), Beta blockade, possible ICD
Ventral Septal Defect
Defect in the ventricular septum - often congenital. Acyanotic heart defect (L-to- R shunt)
Ass/w/ Down’s syndrome
Pansystolic murmur
Pericarditis ECG Changes
PR depression and ST elevation
Wolff Parkinson White Syndrome
Abnormal accessory pathway - leads to tachycardia
ECG: Shortened PR interval and delta wave
Hearing Loss
Sensorineural = air/bone conduction impaired
Conductive = only air conduction impaired
Mixed = air/bone both impaired; air worse than bone
Pulmonary Embolism
- Causes hyperventilation - blowing off CO2 therefore resp alkalosis
ECG changes: S1Q3T3 (large S wave Lead 1; Large Q/inverted T wave Lead 3)
Ventricular Septal Defect
Pansystolic murmur
Heaving apex beat
Signs of pulmonary hypertension and R heart failure
Total anterior circulation stroke
All 3 of the following:
- unilateral weakness (+/- sensory deficit) of face, arm, leg
- Homonymous hemianopia
- Higher cerebral dysfunctioon (dysphasia, visuospatial disorder)
