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Year 3 DPD > Interactive Cases in General Internal Medicine 1 > Flashcards

Interactive Cases in General Internal Medicine 1 Flashcards

1
Q

If a patient has chest pain, what is the most important next investigation?

A

ECG - differentiates STEMI/NSTEMI

if STEMI- give aspirin and clopidogrel and send for PCI

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2
Q

What are the CARDIAC differential diagnoses of chest pain?

A

IHD (angina/MI)
Aortic dissection
Pericarditis

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3
Q

What are the RESPIRATORY ddx of chest pain?

A

PE
Pneumonia
Pneumothorax

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4
Q

What is a giveaway for aortic dissection

A

MAIN ONE = Difference in BP between both arms

  • Sudden onset
  • HTN
  • Listen for aortic regurgitation (early diastolic murmur, collapsing pulse)
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5
Q

What are the GI ddx of chest pain

A

Oesophageal spasm

Oesophagitis, gastritis

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6
Q

What are the MSK ddx of chest pain

A

Costochondritis

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7
Q

With chest pain, what is the order of investigations to do

A

ECG
Troponin (positive = coronary angiography, negative = ETT)
Echocardiography

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8
Q

What are some giveaway signs of pericarditis (infection of outer layer of heart)

A

Worse on inspiration
Better when leaning forward
Fever/flu like illness preceding

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9
Q

What are some giveaway signs of PE

A 
Acute onset breathlessness
Chest pain worse on breathing
Tachypnea
Haemoptysis
Cough
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10
Q

What is an example of someone who has GI related chest pain

A

Eg oesophagitis due to oesophageal candidiasis (if they are on steroid treatment)

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11
Q

Anterior MI will show changes in which leads?

A

V1-4

LAD

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12
Q

Lateral MI will show changes in which leads

A

V5, V6, 1, aVL

Circumflex

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13
Q

Inferior MI will show changes in which leads

A

2, 3, aVF

RCA

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14
Q

Seizure is a cause of collapse - after the episode what usually occurs?

A

Confusion

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15
Q

What are the Ddx of collapse

A
  1. Hypoglycaemia
  2. Cardiac - vasovagal, arrhythmia, outflow obstruction, postural hypotension
  3. Brain - seizure
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16
Q

Arrhythmia as a cause of collapse can be tachycardia or bradycardia. What investigations should be done

A

ECG - look for long QT. If so, put them on cardiac monitor, 24 hour tape

(Long QT = abnormal ventricular repolarisation, congenital or acquired (if low K+/drugs), FH of sudden death)

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17
Q

Outflow obstruction can be a cause of collapse. What are the left and right sided outflow obstructions?

What are the next investigations

A

Left: Aortic stenosis, HOCM (cardiomyopathy)

Right: PE

Investigations: low volume/slow rising pulse, ESM, echocardiogram

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18
Q

For postural hypotension as a cause of collapse, what investigation must be done

A

Lying/standing BP

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19
Q

Right sided murmurs are louder on (inspiration/expiration)?

A

Inspiration

Left sided murmurs louder on expiration

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20
Q

What are the Ddx of raised JVP

A

R heart failure
Tricuspid regurgitation
Constrictive pericarditis

21
Q

Which 3 things can cause a pan-systolic murmur

A

Tricuspid regurgitation
Mitral regurgitation
Ventricular septal defect

22
Q

What are the causes of R heart failure

A
  1. L heart failure

2. Pulmonary hypertension (PE/COPD)

23
Q

What are the causes of tricuspid regurgitation

A

Damaged valve leaflets

Right ventricle dilatation

24
Q

What may be the cause of constrictive pericarditis

A

Infection (TB)
Inflammation (CTD)
Malignancy

25
Q

What are 4 causes of systolic murmurs and how can one distinguish them

A
  1. Aortic stenosis - carotids, slow rising pulse in neck
  2. Mitral regurgitation - displaced apex beat radiating to axilla
  3. Tricuspid regurgitation - loudest in tricuspid area
  4. Ventral septal defect -usually in young person with no other features of cardiac disease
26
Q

SVT and sinus tachycardia have (regular/irregular) pulse rate

A

Regular (but fast)

27
Q

What are the causes of sinus tachycardia

A

Sepsis, hypovolaemia, endocrine causes

28
Q

No p-waves, fast, regular ECG indicates?

A

SVT

29
Q

Atrial fibrillation shows what signs on ECG

A

Fast, irregular

30
Q

SVT can take 2 forms which are

A

AVNRT (re-entry circuit at AVN)

AVRT (up accessory pathway - this is faster.
Delta wave present but won’t see it if they’re in tachycardia. You will see delta wave after treating them though)

31
Q

What are the causes of Atrial fibrillation

A

Thyrotoxicosis, ischaemia, chest infection, alcohol

Heart: IHD, valve, pericardium

Lungs: pneumonia, PE, cancer

32
Q

What are the ECG features of atrial fibrillation

A

No p waves, irregular

Atrial flutter = saw-tooth

33
Q

What are the signs of a ventricular tachycardia

A

Ischaemia, electrolyte imbalance, long QT

VT has fast and broad QRS

34
Q

How do you manage someone with SVT and BP of 120/80

A

Vagal manoeuvres - immense face in cold water e.g.
Adenosine (cardiac monitor) - contraindicated in asthmatics
DC cardioversion if evidence of haemodynamic compromise (e.g. low BP)

35
Q

How do you manage someone with AF and BP of 120/80

A 
Rhythm control (if onset >48 hours, anticoagulant for 3-4 weeks before cardioversion)
Rate control - beta blocker, digoxin
36
Q

How do you manage someone with VT

A

If no haemodynamic compromise - IV amiodarone
Look for and treat underlying cause (low K/Mg)
ICD - implantable cardioverter defibrillator

If they are pulseless with VT, defibrillate

37
Q

What does a deep S wave in V1 and a tall R in V5/6 indicate?

A

LVH - often caused by hypertension

whichever is larger >7 large squares

38
Q

How can you tell 1st degree heart block from an ECG?

A

Prolonged PR interval (should be less than 1 large square)

39
Q

How can you tell 2nd degree heart block from an ECG?

A

P waves without a following QRS complex

40
Q

How can you tell 3rd degree heart block from an ECG?

A

Complete dissociation between atria and ventricles (no relationship between P and QRS)

41
Q

What pathology does this suggest:
ST elevation
T inversion
Q waves

A

Ischaemia (Q waves signify old MI)

42
Q

What should you look at to identify arrhythmias or conduction defects on an ECG

A

Rate, rhythm

PR, QRS, QT

43
Q

What on an ECG may show signs of ventricular strain/hypertrophy

A

Axis, R, S

44
Q

A prominent R wave in V1 shows strain to what part of the heart?

A

Right (e.g. caused by PE)

45
Q

What are each heart sounds associated with?

A 
S1 = Closure of mitral valve
S2 = Closure of aortic valve
S3 = associated with ventricular filling
S4 = Associated with ventricular hypertrophy

Atrial septal defect = fixed wide splitting of S2

46
Q

How do you manage acute heart failure

A
  1. Sit them up and high flow oxygen
  2. Furosemide GTN infusion/diamorphine
  3. GTN infusion/diamorphine
47
Q

How do you manage someone with VF / pulseless VT

ALS question

A 
Shock
CPR (2 min)
Assess rhythm
Adrenaline every 3-5 mins
Correct reversible causes
48
Q

How do you manage someone with asystole

A

CPR

Correct reversible causes

49
Q

What are the Ddx of pleuritic chest pain

Pleuritic chest pain worse when breathing in

A 
Pericarditis
PE
Pneumonia
Pneumothorax
Pleural pathology

Sub-diaphramatic pathology

Year 3 DPD (2 decks)

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