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General Finals & SBA Review > Laz Cardiology > Flashcards

Laz Cardiology Flashcards

1
Q

Left bundle branch block signs on ECG

A

Broad QRS (>0.12)
WiLLiaM MaRRoW
So will see W in V1 and M in V6

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2
Q

Definition of angina

A

Chest pain on exertion, relieved by rest

It’s because there is a mismatch in oxygen supply and demand to myocardium

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3
Q

Treatment of stable angina

A

Beta blockers (reduce the heart rate). This helps with the mismatch between oxygen and myocardium! Because not working as hard.

GTN spray

Risk factor modification

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4
Q

ACS is what?

A

Symptoms caused by a sudden reduced blood flow to the heart muscle

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5
Q

First line investigation in ACS

A

ECG

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6
Q

ACS Sx with no ST elevation, what do you do?

A

Troponin

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7
Q

ACS Sx, no ST elevation, raised troponin =>

A

NSTEMI

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8
Q

Ischaemic changes on ECG

A

Dynamic T wave inversion (a new finding, because can be normal). Try to find a previous ECG!
ST depression

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9
Q

Generic ACS management

A

Morphine 5-10mg
10mg metoclopramide to help with nausea from morphine

300mg aspirin
300mg clopidogrel
Or
180mg ticagrelor

GTN spray

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10
Q

How many medications do ACS patients get discharged on?

A

5

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11
Q

Discharge medications for MI

A 
Aspirin 75mg 
Clopidogrel 75mg 
Bisoprolol (beta blocker) 2.5mg 
ACEi 2.5mg 
Statin 80mg

All once daily

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12
Q

Aim of STEMI Mx

A

Establish coronary repurfusion

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13
Q

STEMI Mx <12hr

A

PCI

Only if you can get PCI within 2hr of diagnosis

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14
Q

STEMI Mx >12hr

A

Angiography followed by PCI if necessary

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15
Q

If they have a STEMI <12hr but you cannot get PCI in less than 2 hours, what do you do?

A

Thrombolysis

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16
Q

Management of NSTEMI

A

Give 2.5mg SC fondaparinux
Do a GRACE score to determine risk
High risk -> angiography
Low risk -> medical management

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17
Q

All patients undergoing PCI should be on what medication to prevent the wire causing clotting?

A

IV unfractionated heparin

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18
Q

What type of drug is tacrolimus?

A

Calcineurin inhibitor

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19
Q

What is impregnated into a coronary stent?

A

Tacrolimus

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20
Q

Definition of heart failure

A

Inability of the heart to pump sufficiently to meet the demands of the body

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21
Q

Which side of the heart does the blood come from the body

A

Right side

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22
Q

Which side of the heart does blood come from the lungs?

A

Left side

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23
Q

ABCDE of pulmonary oedema

A 
Alveolar oedema 
Kerly B lines 
Cardiomegaly 
Upper lobe diversion
Pleural effusion
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24
Q

Causes of heart failure

A

IHD
Valvular disease
HTN

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25
Q

Sudden heart failure Ix

A 
ECG 
Chest X-ray 
ABG 
Echo
BNP
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26
Q

Management of acute heart failure

A

Sit the patient up
Oxygen 15/L non-rebreathe
Diuretics 40mg furosemide IV to clear some fluid
If already on diuretics (acute on chronic) go for higher dose of 80mg furosemide
GTN spray
5mg morphine IV

27
Q

Long term heart failure management

A

Beta blocker
ACEi
Risk factor modification

28
Q

Acute heart failure, you’ve sat them up, oxygen, GTN, morphine, furosemide 80mg, they are still bad, what do you do?

A

CPAP

29
Q

Great explanation by Laz about oxygen therapy and ventilation. In a poorly functioning lung, there will be bits that are working ok and bits that aren’t working very well.
How does oxygen therapy work and how does ventilation work?

A

Oxygen therapy looks to help the bits that are already working, by increasing the diffusion gradient
Ventilation works by recruiting more of the dysfunctioning lung

30
Q

Analogy for CPAP

A

Putting your head out of the car window, constant light pressure pushing air in and opening alveoli to aid ventilation

31
Q

Summary of BiPAP using IPAP and EPAP

A

IPAP is higher than EPAP

I.e. air is pushed in

32
Q

Why do we start someone on CPAP?

A

Say they are COPD, the airway is fragile and so when you try to breathe out, the airways collapse and lock off
CPAP keeps those alveoli open
Increases the surface area that is participating in gas exchange

33
Q

Why do we start someone on BiPAP?

A

Keeps the alveoli open but then also aids in clearing the CO2!
So this is good for type 2 respiratory failure!

34
Q

Causes of AF

A 
Very common, loads of things can precipitate it
Idiopathic
Cold drinks 
Drugs
Pneumonia
PE
Alcohol
Hyperthyroidism 
IHD
35
Q

What is AF

A

Irregularly irregular rhythm with no P waves

36
Q

Cause of DVT, which aspect of Virchows does it influence, what do you give?

A

Stasis

Give anticoagulant

37
Q

MI affects which part of virchows triad? What do you give?

A

Vessel wall injury (from plaque rupture)
Get platelet activation (because exposed tissue factor)
So need anti platelets

38
Q

Examples of anticaogulants

A

Heparin

Rivoroxaban

39
Q

Examples of anti platelets

A

Clopidogrel

Aspirin

40
Q

A regular, narrow complex tachycardia is called

A

SVT
Supraventricular tachycardia
Remember that the QRS are narrow so it’s an atrial issue

41
Q

Adenosine is contraindicated in which common condition?

A

Asthma

It can cause bronchoconstriction

42
Q

Urine dip in endocarditis may show

A

Microscopic haematuria

43
Q

Features of endocarditis

A 
4 day fever 
Needle track marks 
Microscopic haematuria  
Splenomegaly 
Jane way lesions
Oslers nodes 
Roth spots on retina
44
Q

Causes of murmurs

A

Endocarditis
IHD
Senile calcification
Rheumatic heart disease

45
Q

Why are murmurs on left side more likely?

A

Higher pressures

46
Q

What usually causes RHS murmurs

A

Infection, because it’s the first valve it hits (tricuspid)

47
Q

What is flecanide used for?

A

Dangerous arrhythmias

48
Q

6 Ps of acute limb ischaemia

A 
Pale
Pulseless
Parasthesia
Perishingly cold
Paralysis 
Painful
49
Q

Analogy of acute limb ischaemia

A

MI of the leg, embolus going down aorta and getting stuck in leg arteries

50
Q

Management of acute limb ischaemia

A

IV heparin

Refer to vascular surgeon

51
Q

Vascular surgeon options for acute limb ischaemia

A

Embolectomy
Bypass
Amputation

52
Q

Analogy of intermittent claudication

A

Stable angina!

53
Q

Critical limb ischaemia analogy

A

Unstable angina

54
Q

Features of critical limb ischaemia

A

Ulcers
Gangrene
Rest pain
Night pain

55
Q

Ix for intermittent claudication

A

ABPI

Venous duplex USS

56
Q

Small T waves
Prolonged PR interval
Symptoms of DKA
Electrolyte abnormality?

A

Hypokalaemia

57
Q

Management of digoxin toxicity

A

Immediate digoxin level
IV fluids
Correct electrolyte abnormalities
Continuous cardiac monitoring

58
Q

Ix for ischaemic stroke

A

CT head
Diffusion-weighted MRI
Look for causes = carotid artery doppler, ECG, echo

59
Q

Causes of raised anion gap

A 
MUDPILES
Metformin 
Uraemia
DKA
Paracetamol
Iron
Lactic acidosis
Eythyl 
Salicylate
60
Q

Which antibiotic for penicillin allergic for strep throat?

A

Clarithromycin

61
Q

Swollen gums
Anaemia
Easy bruising
Restricted diet

A

Vitamin C deficiency

Scurvy

62
Q

What is tympanosclerosis

A

Tympanosclerosis is a condition characterised by chronic inflammation and scarring of the tympanic membrane leading to subsequent calcification of the tympanic membrane and associated structures.

Associated with long term otitis media and tympanostomy (grommet) insertion. Patients will normally present with significant hearing loss and on examination will present with chalky white patches on the tympanic membrane.

Hearing aids are a common treatment for hearing loss disorders. In cases refractory to hearing aids, excision of the sclerotic areas and repair of the ossicular chain may be considered.

63
Q

Treatment of chronic otitis externa (episodes of painful ear with white discharge)

A

Aural toilet and topical antibiotic

64
Q

What are the complications of otitis externa?

A

Mastoiditis

Labyrinthitis

General Finals & SBA Review (8 decks)

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