January Flashcards
how can PPI cause muscle aches?
long term use of PPI can cause hypomagnesaemia which can cause muscle weakness and aches, begins after 3 months to 1 year of using
side effects of using PPIs
hyponatraemia, hypomagnasaemia
osteoporosis
increased Cdiff risk
what size changes can be seen on renal ultrasound in CKD?
bilateral smaller kidneys
what conditions are associated with enlarged kidneys on renal ultrasound
HIV associated nephropathy, PCKD, diabetic nephropathy and amyloidosis
if someone is found to be in AF with no symptoms, how to determine if going to anticoagulate or not?
chadvasc2 score
what diuretic to use in someone with ascites secondary to alcoholic liver disease?
spironolactone - aldosterone antagonist
what part of the colon is most likely to be affected by ischaemic colitis?
splenic flexure - watershed area
risk factors of bowel ischaemia?
increasing age AF embolic conditions - cancer, endocarditis cardiovascular disease risk factors cocaine
what is the pattern of pain for mesenteric ischaemia?
sudden and severe
features of bowel ischaemia?
abdo pain rectal bleeding diarrhea fever leucocytosis + lactic acidosis
difference between mesenteric ischaemia and ischaemic colitis?
mesenteric ischaemia tends to be sudden and severe requiring urgent surgical treatment
ischaemic colitis can be transient and chronic, resulting in inflammation, ulceration and haemorrhage.
what murmur is associated with aortic dissection?
aortic regurgitation
if someone describes a tearing chest pain, what additional observations to be done?
right and left arm blood pressure
what ECG changes can be seen in aortic dissection?
inferior ST-elevation due to right coronary artery involvement of dissection
in addisons disease what can be seen in serum Sodium and potassium?
hyponatraemia and hyperkalaemia
What electrolyte imbalance is associated with sarcoidosis, why?
Hypercalcaemia due to inappropriate activation of vitamin D by macrophages within granulomas
What blood test can be used if sarcoidosis is suspected
Serum ACE
Dry cough, fever, dyspnea, 3 months after solid body organ transplant. What’s a likely diagnosis?
CMV pneumonitis
What is a contraindication of Hartmanns solution?
Hyperkalaemia - contains potassium
How to diagnose Cushing’s disease ?
High acth, not surprised by low dose dex test but surprised by high dose dex test
cortisol not suppressed by low and high dose dex, what is the likely cause ?
Ectopic acth production
WhT are the features of myeloma?
Crab
High calcium
Renal failure
Anaemia
Bone pain
What is the biochemical picture for myeloma? Calcium phosphate alp
High calcium normal/high phos normal alp
Definition of pathological Q waves?
> 1mm wide and >2mm deep
What do ST segments do in prinzmental angina?
ST elevation
Which T wave leads are usually inverted?
aVR and V1
When are U waves seen
Hypokalaemia
Describe 2nd degree type 2 heart block
Constant PR interval with occasional drops in QRS complexes
Describe QRS complexes in 3rd degree heart block
Constant rate separate to P waves, may merge with P waves, abnormal shape
In cor pulmonale with BBB, will it be left or right?
Right BBB
Difference between atrial escape and junctional escape
Junctional escape beats will not have P waves but normal QRS-T waves
How can mitral stenosis affect P waves on ECG?
Bifid P wave, broad P wave in lead II
What do tall peaked p waves in lead II signify?
Cor pulmonale - right atrial enlargement
Characteristic of wolf parkinson white syndrome on ECG?
Delta wave - slurred upstroke of R wave
What does Coved ST elevation in V1 2 3 indicate
Brugada syndrome
What is cushing’s reflex?
Increased ICP - bradycardia, hypertension, irregular breathing
What must be done to patient before giving DC cardioversion
Sedation
4T and 4H reversible causes of asystole
Tamponade
Toxin
Tension pneumothorax
Thrombus
Hypovolaemia
Hypothermia
Hyperkalaemia/hypokalaemia etc
Hypoxia
Drugs of choice for rhythm control in acute AF
Flecainide or amiodarone
When to use digoxin in AF?
If old and sedentary
Significance of chadvasc2 score 1 2 male female
1 - anticoagulate for males
2 - anticooagulate for females
Complications of MI
DARTH VADER
Death Arrythmias Rupture Tamponade Heart failure
Valve disease Aneurysm Dressler syndrome Embolus Recurrence
Possible ECG changes in pulmonary embolism
S1Q3T3 - deep S wave in I, pathological Q in III, TWI in III
Right heart strain signs - right axis deviation, dominant R wave and TWI in V1-V3
ECG changes In hyperkalaemia?
Tall tented T waves Widened QRS Absent P wave Sine wave appearance Torsade de pointe
