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Phase 2b > LICP questions > Flashcards

LICP questions Flashcards

1
Q

What would confirm a diagnosis of angina?

A

Coronary angiography

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2
Q

What would a typical history of stable angina involve?

A

Gripping, tight crushing chest pain that radiates to the left arm. Exacerbated by exercise and relieved by GTN

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3
Q

What is a possible surgical interventional for angina?

A

Stent with ballon angiography

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4
Q

What features in the history help to decide whether this is cardiac chest pain, typical or atypical?

A

Characteristics of the pain -

Location
Radiation 
Severity 
Duration 
Frequency 
Provoking and relieving factors
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5
Q

How to distinguish stable angina from ACS/MI?

A

Relationship to physical exertion, relieved by rest or glyceryl trinitrate within about 5 minutes

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6
Q

What are the major risk factors for coronary artery disease?

A

Cardiovascular risk factors -

HTN 
Hyperlipidaemia
DM
FH
smoking
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7
Q

When do you consider aortic stenosis as a differential for coronary artery disease?

A

Crescendo-decrescendo systolic murmur

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8
Q

What is secondary prevention, diet and lifestyle measures and medications

A

Secondary prevention - reducing impact of disease by early identification

Diet - Healthy eating, lower calorie, lower fat diet

Lifestyle: smoking cessation, exercise, weight loss

Medication - DAPT if CHADVASC indicates, beta blockers, flu jab, ACEi for bp

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9
Q

How is angina graded?

A

Functional status - canadian cardiac society

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10
Q

Outline a cardiac examination?

A
  1. Introduction
  2. General inspection
  3. Hands
  4. Pulses and BP
  5. Eyes and mouth
  6. Close inspection of the chest
  7. Palpation
  8. Auscultation
  9. Final steps: posterior chest, sacral odema, legs
  10. Closing
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11
Q

Outline a cardiac examination?

A
  1. Introduction
  2. General inspection
  3. Hands
  4. Pulses and BP
  5. Eyes and mouth
  6. Close inspection of the chest
  7. Palpation
  8. Auscultation
  9. Final steps: posterior chest, sacral odema, legs
  10. Closing
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12
Q

What pulses and pressures need to measured in a cardiac examination?

A 
Radial pulse 
Brachial pulse 
BP 
Carotid pulse 
JVP
Hepatojugular reflex
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13
Q

How do you measure JVP?

A
  1. Position the patient in a semi recumbent position
  2. Ask the patient to turn their head to the left
  3. Inspect for evidence of IJVP from the medial end of the clavicle, under medial SCM and to the ear lobe
  4. Measure by assessing the vertical distance between the sternal angle and the top of the IJV (≤3)
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14
Q

What is a positive hepatojugular reflex?

A

Raised JVP when pressure is applied to the liver and ≥4cm

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15
Q

What are the symptoms of left sided heart failure?

A

BLUE BLOATER

\+Paroxysmal nocturnal cough 
\+ Elevated pulmonary capillary wedge pressure 
\+Pulmonary congestions (cough, crackles, wheezes, tachypnoea 
\+ Restlessness 
\+ Confusion 
\+ Orthopnoea 
\+ Cyanosis 
\+ Extertional dyspnoea
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16
Q

What are are the symptoms of right sided heart failure?

A

PINK PUFFER

\+ Fatigue 
\+ Increased peripheral venous pressure 
\+Ascities 
\+ Enlarged liver and spleen 
\+ Distended jugular veins 
\+ GI problems and anorexia 
\+ Weight gain 
\+ Pitting oedema
17
Q

With regard to shortness of breath, what suggested that this may be due to right sided heart failure?

A

Ankle/abdomen swelling, fatigue/tiredness, weight gain ( over 2kg in a week)

18
Q

What differentials for heart failure should be considered?

A 
Valvular disease 
Cardiomyopathy
Severe HTN
ACS 
Respiratory disorders e.g. COPD
19
Q

What is the NYHA classification?

A

A classification that groups patients with heart failure into one of four classes depending on their symptoms during activity and at rest

20
Q

Explain the NYHA classifications?

A

II - slight limitation of activity
III - marked limitation of activity but comfortable at rest
IV - unable to carry on without discomfort, symptoms of heart failure at rest

21
Q

What are the precipitating factors for heart failure?

A 
Arrhythmia 
Myocardial ischaemia 
Pneumonia 
HTN 
Worsening renal function
22
Q

Which signs are more specific to heart failure?

A

Can’t lie flat when sleeping

Sudden weight gain

New onset dizziness or confusion

23
Q

What are the five main types of arrhythmias?

A
  1. Sinus arrhythmia
  2. Premature beats
  3. Brady and tachy
  4. Atrial vs. junctional vs. ventricular
  5. Heart blocks
24
Q

What features help distinguish sinus tachycardia from an abnormal heart rhythm

A

Onset off set of palpitations

May feel like they’ve missed a beat or feel like a thud

25
Q

What features may help distinguish SVT from AF?

A

+ Polyuria after episode of SVT

+ Relief via vagal exercises in SVT

26
Q

What features make it more likely that the cause of palpitations is abnormal heart rhythm?

A
  • Patients with congestive heart failure
  • Patients with hypotension
  • Patients with angina/ischaemia
27
Q

What features will help with risk stratification?

A

Family history of:
heart rhythm disturbance
syncope
sudden cardiac death

28
Q

What are the features of asthma?

A
  • Intermittent airflow obstruction
  • Presents frequently in younger people
  • Improvement in airways with bronchodilators and steroids
  • Cellular inflammation with eosinophils, mast cells and t lymphocytes
29
Q

What are the features of COPD?

A
  • Progressive airway obstruction
  • Nearly always a smoker presenting over 60
  • Less reversibility
30
Q

Major risk factors for COPD?

A

Smoking
Occupation
Pollution

31
Q

What tests can tell you about the severity of COPD?

A

Spirometry
CXR
HRCT

32
Q

What are the complications of COPD?

A 
\+ Lung infections 
\+ Lung cancer 
\+ Heart failure 
\+ Depression
\+ Obestiy from not excersing
33
Q

Important differentials for COPD?

A 
\+ PE 
\+ Pneumothorax 
\+Asthma 
\+ Pneumonia 
\+ Lung cancer
34
Q

What features will distinguish between lung cancer, infection/ PE/ Vasculitis?

A

Associated, constant and severe bone pain

Headaches

Facial and neck mets and SVCO

35
Q

Biggest risk factor for lung cancer?

A

Smoking

36
Q

How do you stage lung cancer?

A

TNM staging

37
Q

What are the histological subtypes?

A

Broadly:

Small cell and non small cell

38
Q

What tests would you do to confirm lung cancer?

A

CXR, CT, PET and bronchoscopy

39
Q

Complications of lung cancer?

A

Brain mets, SVCO, bone mets, pleural effusion, hyponatremia and hypercalcaemia

Phase 2b (2 decks)

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