IMT Knowledge Flashcards
What is the time limit guideline for PCI in STEMI?
2 hours of ECG diagnosis (pre-hsopital) or 1 hour (hospital diagnosis)
What is the time limit for thrombolysis in STEMI?
12 hours
Which patients with NSTEMI may be considered for immediate PCI?
CV unstable
Patients with NSTEMI and high GRACE score should be considered for…
PCI within 72 hours
Give ECG findings which may suggest NSTEMI
TWI, ST depression, Q waves
Which coronary artery is usually implicated in anterolateral MI?
LCA
Which coronary artery is usually implicated in lateral MI?
Circumflex
Which coronary artery is usually implicated in anterior MI?
LAD
Which coronary artery is usually implicated in inferior MI?
RCA
How is fast AF treated?
Rate control (beta-blocker +/- amiodarone) and anticoagulation
How is stable SVT usually treated?
Adenosine 6mg IV, can give 12 - 18mg if unsuccessful, may require cardioversion
What is the treatment for stable VT?
Amiodarone 300mg
What are the mainstays of management for exacerbation of COPD?
Ipratropium
Salbutamol
Oxygen
Antibiotics (if infective)
Prednisolone
What are the main treatments for exacerbation of asthma?
Oxygen
Salbutamol
Hydrocortisone
Ipratropium
Theophylline
Magnesium
Anaesthetis
Which features suggest a severe asthma exacerbation?
Unable to complete sentences
Increased WOB
Peak flow < 50%
Sats < 92%
Raised ++ HR/RR for age
Which features suggest a life-threatening asthma exacerbation?
Peak flow < 33%
Exhaustion
Hypotension
Silent chest
Cyanosis
Confusion
Which sign on an ABG is concerning in acute asthma?
Rising pCO2
Which finding may be found on ABG in a patient with PE?
Respiratory alkalosis
How are patients with a stable PE treated?
anticoagulate with DOAC or LMWH
How are patients with an unstable PE treated?
continuous infusion unfractionated heparin +/- thrombolysis
What are the mainstays of DKA treatment?
Fluid resuscitation, insulin and electrolyte replacement (esp K)
Give examples of stroke mimics.
Hypoglycaemia
Seizures
FND
SOL
Electrolyte imbalance
What are the main treatment options for stroke caused by an infarct?
Thrombolysis and Thrombectomy
What scoring system can be used for stroke?
NIHSS
What is the usual timeframe for thrombolysis?
4.5h
What is the usual timeframe for thrombectomy?
Usually 6h but can be performed up to 24h
Which protocol may need to be activated in UGIB?
Major Haemorrhage
Which treatments may be considered for variceal bleeding?
Terlipressin
pAbx
Definitive - ligation, banding
What is involved in the ‘sepsis six’?
Give 3 - antibiotics, fluids, oxygen
Take 3 - cultures, urine output, lactate
What is the treatment for anaphylaxis?
IM adrenaline 500mcg (1ml 1 in 1000)
Which ECG changes may suggest hyperkalaemia?
Tented T waves, prolonged PR interval, prolonged QRS
What is the treatment for hyperkalaemia?
Calcium gluconate 10% 10mls to stabilise myocardium
Insulin/dextrose infusion
Sometimes nebulised salb recommended
Give some common causes of delirium.
PINCHME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
What is meant by status epilepticus?
Seizure > 5 mins or not recovering between multiple seizures
What initial treatments and doses could be given in status epilepticus?
10mg buccal midazolam or PR diazepam
What is the most important part of your assessment in status epilepticus?
Airway
What is the treatment for status epilepticus?
benzo such as midazolam, repeated after 5 mins if no response
2nd/3rd line include levetiracetam, phenytoin etc
May require RSI and intubation
Which symptoms may be present in adrenal insufficiency?
Dizziness, vomiting, reduced GCS
Give common triggers for adrenal insufficiency.
Infection, surgery, exogenous steroid withdrawal
What is the biochemical pattern seen in adrenal crisis?
Hyponatraemia, hyperkalaemia, hypoglycaemia
Hypoadrenalism leads to deficiency of…
Mineralocorticoids and glucocorticoids
Rapid correction of sodium can lead to…
central pontine myelinolysis
Give differential diagnoses for chest pain.
ACS, PE, Pneumothorax, dissection, boerhavve’s
Give examples of features which may suggest high risk in NSTEMI.
Poor LV function
Previous CABG
Other co-morbidities
Raised trop
Arrythmia
What is the usual treatment for DVT?
DOAC
Give potential causes for ‘unprovoked’ DVT.
Malignancy
Clotting issues inc thrombophilia
How was IMT as a training programme conceived?
Transitioned from CMT in 2019 after ‘Shape of Training’ review
How does IMT differ from previous CMT?
Addition of IMT3, allows for a ‘bridge’ between SHO and Reg level, usually working as a junior reg with support
What are the three main aspects to the IMT curriculum?
Capabilities in Practice (CiPs), clinical knowledge, and procedures
What are the indications for emergency dialysis?
Refractory hyperkalaemia
Metabolic acidosis
Fluid overload unresponsive to treatment
Symptoms of uraemia
Which classification score is used for stroke?
Oxford-Bamford
What is meant by a Total Anterior Circulation Stroke (TACS)?
3/3 features of weakness, hemianopia, cognitive
What is meant by TACS?
2/3 features of weakness, hemianopia, cognitive OR cognitive alone
What is meant by lacunar stroke?
pure motor/sensory without higher cognitive dysfunction
This remains important in prognosticatio
What is the treatment for addisonian crisis?
100mg methylpred
What is the mechanism for adrenal crisis when steroids omitted?
Due to exogenous steroids, HPA axis becomes down-regulated meaning insufficient endogenous steroid production
Which criteria can be used to differentiate exudative and transudative pleural effusion?
Light’s criteria
Which factors are involved in Light’s criteria?
Serum/pleural LDH and serum/pleural protein
What is the pathophysiology of an exudative effusion?
Leakage of protein out of pleural space
What is the pathophysiology of a transudative effusion?
Fluid leaking INTO pleural space
What is the most common cause of a unilateral pleural effusion?
Malignancy
Give causes of exudative pleural effusion.
Malignancy
Pneumonia
RA
TB
Give causes of transudative pleural effusion.
Heart failure
Hypoalbuminaemia
Hypothyroidism
Meig’s syndrome
