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HBP Flashcards

1
Q

Noradrenaline

A

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.

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2
Q

Carcionoid Syndrome

A 
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
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3
Q

Carcionoid Tumours

A

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)
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4
Q

Pleural Effusion

A

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.

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5
Q

Pleural Effusion: Types

A

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)

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6
Q

Conditions ass/w/ Transudate Pleural Effusions

A
  • Congestive heart failure
  • Liver cirrhosis
  • Severe hypoalbuminaemia
  • Nephrotic syndrome
  • Acute atelectasis
  • Myxedema
  • Peritoneal dialysis
  • Meig’s syndrome
  • End stage kidney disease
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7
Q

Conditions ass/w/ Exudative Pleural Effusions

A

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
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8
Q

Acute Respiratory Distress Syndrome

A

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

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9
Q

Vasculitis

A 
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
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10
Q

Multiple Myeloma

A

Haematological malignancy characterised by plasma cell proliferation. Genetic mutations when b-lymphocytes differentiate into mature plasma cells.

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11
Q

Multiple Myeloma: Presentation

A

Usual age 70 years.
CRAB:
- Calcium: hypercalcaemia (↑osteocalsts activity in bones leads to constipation, nausea, anorexia and confusion)
- Renal failure:

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12
Q

Hyperkalaemia Management

A
  • 10 units of actrapid plus glucose (pushes K+ into the cells)
  • Calcium Gluconate - stabilize the cardiac memebrane to stop arrhythmias
  • Neb salbutamol
  • Calcium resonium
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13
Q

Types of Respiratory Failure

A

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

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14
Q

Ludwig’s angina

A

Severe cellulitis affecting the floor of the mouth. Often caused by a dental infection

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15
Q

Anaphylaxis Management

A

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

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16
Q

Anapylaxis Clinical Signs

A

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)
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17
Q

Anaphylaxis Investigations

A

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

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18
Q

Pulmonary Embolism: Risk Factors

A
  • Recent surgery
  • Recent fractures
  • Recent immobility
  • Personal/FHx of clotting disorder/PE/DVT
  • Obesity
  • Malignancy
  • Infection
  • Pregnancy
  • COCP/HRT
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19
Q

Pulmonary Embolism: Symptoms

A
  • Shortness of breath
  • Plueritic chest pain (on inspiration)
  • Cough
  • Haemoptysis (from infarcted lung tissue)
  • Dizziness/syncope
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20
Q

Pulmonary Embolism: Signs

A
  • 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
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21
Q

Pulmonary Embolism: Investigations

A

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)

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22
Q

Reversible Causes of Cardiac Arrest (4 H’s and 4 T’s)

A 
Hypovolaemia (shock/perfusion)
Hypothermia (Bair hugger)
Hyperkalaemia (aggressive fluid resus to correct electrolytes)
Hypoxia (maintain airway)
Thrombosis
Tension pneumothorax
Toxins
Tamponade
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23
Q

Benign Prostatic Hyperplasia (BPH)

A

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!

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24
Q

Prostate Cancer

A

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

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25
Q

Haematuria Causes

A
  • Infection (cystitis, prostatitis, urethritis)
  • Tumour (renal cancer, Wilms’ tumour, bladder, prostate, urethral cancer)
  • Trauma
  • Inflammation (glomerulonephritis)
  • Structural (calculi, cysts)
  • Haematological (sickle cell)
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26
Q

Atrial Fibrillation

A

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

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27
Q

Atrial Fibrillation: Presentation

A
  • Breathless/dyspnoea
  • Palpitations
  • Syncope/dizziness
  • Chest discomfort
  • Stroke/TIA
28
Q

Atrial Fibrillation: Investigations

A
  • 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)
29
Q

Upper Motor Neurone Signs

A 
Hypertonia
Weakness
Paralysis
Hyperreflexia 
Spasticity
Positive Babinski sign (toes point upwards)
Clonus
30
Q

Lower motor neurone signs

A 
Hyporelfexia
Hypotonia
Muscle weakness/paralysis
Fasiculations
Muscle atrophy
31
Q

Rebound Tenderness

A

Indicates peritoneal inflammation

Marker of severity - if + more severe

32
Q

Wernicke’s Encephalopathy

A

Vitamin B1 (Thiamine) deficiency

Triad of encephalopathy, gait ataxia and nystagmus

Tx: Pabrinex (contains thiamine)

33
Q

Alcohol Withdrawal Tx

A
  • Pabrinex (Thiamine complex)
  • Fluids to correct dehydration/electrolyte imbalance
  • Chlordiazepoxide (sedative benzo; less addictive than other benzos)
34
Q

Korsakoff’s syndrome

A

Longer term complication of WE –> nonreversible

  • loss of short term memory
  • confabulation
  • lack of insight
  • retrograde amnesia
  • apathy
  • lack of insight
35
Q

Delirium Tremens

A

Fever, marked tremor, tachycardia, agitation and hallucinations, hyperthermia, severe agitation, diaphoresis

Tx: IV Pabrinex; Fluids to correct dehydration/electrolyte imbalance (hypoPhos/Mg); Chlordiazedpoxide

36
Q

Alpha1-antitrypsin

A

Early onset COPD and cirrhosis

37
Q

Budd-Chiari

A

Clots in the portal hypertension - leads to liver necrosis

38
Q

Hepatic Encephalopathy

A

Personality change, intellectual impairment, decreased consciousness

Tx: Laxatives, Rifampicin (to reduce ammonia), NG feeding

  • Exclude intracranial pathology
39
Q

Child-Pugh Classification of Cirrhosis

A

Uses bilirubin, albumin, PT time, ascites and hepatic encephalopathy
- Used to assess severity, Tx, eligible for transplant

40
Q

Pancreatitis

A

Use Glasgow score - LDH

41
Q

Surgical Sieve

A 
VITAMIN C, D:
Vascular
Infection/Inflammatory
Trauma
Autoimmune
Metabolic
Idiopathic
Neoplastic
Congenital
Degenerative
42
Q

Anaphylaxis

A

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

43
Q

Pulmonary Embolism

A

Resp Alkalosis; Wells score
Tx: O2 and LMWH treatment dose
Ix: VQ scan - CTPA

44
Q

Diabetic Ketoacidosis (DKA)

A

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

45
Q

Diabetic Ketoacidosis (DKA) Signs and Symps

A
  • Dehydrated
  • Breath smells of ketones (pear-drops/nail polish remover)
  • Compensating for the metabolic acidosis - Kussmaul breathing
  • Abdo pain/D&V
46
Q

Diabetic Ketoacidosis (DKA) Ix

A
  • 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
47
Q

Diabetic Ketoacidosis (DKA) Tx

A
  • 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
48
Q

Reversible Causes of Cardiac Arrest (4H’s and 4T’s)

A
  • Hypovolaemia
  • Hypothermia
  • Hyperkalaemia
  • Hypoxia
  • Thrombosis
  • Tension pneumothorax
  • Toxins
  • Tamponade
49
Q

Infective Endocarditis

A

Risk Factors: Prev endocarditis, Rhemumatic Heart disease (strep pyogenes), IVDU
Causes: Strep viridans/Strep aureus
Dx using Modified Duke criteria

50
Q

Heart Failure Investigations

A

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)

51
Q

Heart Failure Pharmacological Tx

A

Diuretics (loop/thiazide) + ACEI (or ARB) + Beta Blocker

52
Q

Mitral Stenosis

A

commonly caused by Rheumatic fever
Mid-diastolic murmur
Ass/w/ Malar flush, AF and L parasternal heave

53
Q

Mitral Regurgitation

A

commonly caused by mitral valve prolapse

54
Q

Aortic Stenosis

A

Commonest valve lesion - degenerative calcific leading to compensatory LVH
- triad of dyspnoea, angina and syncope
- radiates to carotids
Ix: Dobutamine stress test

55
Q

Aortic Regurgitation

A

Rheumatic heart disease, aortic root disease (Marfan’s, aortic dissection)
- collapsing pulse

56
Q

Atrial Fibrillation Ix

A

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)

57
Q

Atrial Fibrillation Tx

A

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

58
Q

Atrial Fibrillation Anti-coagulation

A

CHADS2 score >= 2 then warfarin

Lower risk = aspirin/clopidogrel

59
Q

Long QT Syndrome

A

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

60
Q

Ventral Septal Defect

A

Defect in the ventricular septum - often congenital. Acyanotic heart defect (L-to- R shunt)
Ass/w/ Down’s syndrome
Pansystolic murmur

61
Q

Pericarditis ECG Changes

A

PR depression and ST elevation

62
Q

Wolff Parkinson White Syndrome

A

Abnormal accessory pathway - leads to tachycardia

ECG: Shortened PR interval and delta wave

63
Q

Hearing Loss

A

Sensorineural = air/bone conduction impaired

Conductive = only air conduction impaired

Mixed = air/bone both impaired; air worse than bone

64
Q

Pulmonary Embolism

A
  • Causes hyperventilation - blowing off CO2 therefore resp alkalosis

ECG changes: S1Q3T3 (large S wave Lead 1; Large Q/inverted T wave Lead 3)

65
Q

Ventricular Septal Defect

A

Pansystolic murmur
Heaving apex beat
Signs of pulmonary hypertension and R heart failure

66
Q

Total anterior circulation stroke

A

All 3 of the following:

  1. unilateral weakness (+/- sensory deficit) of face, arm, leg
  2. Homonymous hemianopia
  3. Higher cerebral dysfunctioon (dysphasia, visuospatial disorder)

HBP (1 decks)

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