Lipworth Flashcards

1
Q

Raised JVP with v waves

A

Pulmonary hypertension / right heart failure

v waves due to tricuspid regurgitation

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2
Q

Clinical signs of pulmonary hypertension/right heart failure

A

Central cyanosis if hypoxic
• Dependent oedema
• Raised JVP with V waves (due to secondary tricuspid regurg)
• Right ventricular heave at left parasternal edge
• Murmur of tricuspid regurgitation
• Load P2
• Enlarged liver (pulsatile )

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3
Q

Treatment for Primary Pulmonary Hypertension

A

Pharmacologic Treatment

  • prophylactic anticoagulation [warfarin]
  • O2 if hypoxic
  • Po Vasodilators :Endothelin antagonist (Oral Bosentan) , PDE5-inhibitor (Oral Sildenafil), iv Epoprostenol
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4
Q

Causes of pulmonary hypertension

A

Blood clots in the lungs (pulmonary emboli)
Chronic obstructive pulmonary diseases, such as emphysema.
Connective tissue disorders, such as scleroderma or lupus.
Sleep apnea and other sleep disorders.
Heart abnormalities you’re born with (congenital heart defects

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5
Q

What type of respiratory failure follows PE?

A

• Arterial blood gases-↓PaO2,↓Sao2

Type 1 resp failure:PaCO2 normal or low

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6
Q

Clinical signs of PE

A

Clinical presentation depends on size:
• Large-cardiovascular shock,low BP,central cyanosis,sudden death
• Medium-pleuritic pain,haemoptysis,breathless
• Small recurrent-progressive dyspnoea, pulmonary hypertension and right heart failure
Diagnosis of PE #1
• Clinical Signs- Tachycardia,Tachypnoea,Cyanosis,Fever Low BP,Crackles, Rub, Pleural effusion

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7
Q

Auscultation of the lungs in PE

A

Crackles, rub

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8
Q

PE ECG findings

A

ECG :Acute Rt heart strain pattern (S1,Q3,T3 , T inv in V1-3)

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9
Q

ECG :Acute Rt heart strain pattern (S1,Q3,T3 , T inv in V1-3)

A

Pulmonary embolism

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10
Q

Diagnosis of pulmonary embolism

A

• ECG :Acute Rt heart strain pattern (S1,Q3,T3 , T inv in V1-3)
• D-dimers usually raised
• Isotope lung scan (Ventilation/Perfusion)
• Perfusion defect before infarction
• Perfusion+Ventilation matched defect after infarction
CT pulmonary angiogram to image pulmonary artery filling defect
• Leg and pelvic ultrasound to detect silent DVT
• Echocardiogram to measure pulmonary artery pressure and RV size
• Gas transfer factor (TLCO) to measure perfusion defect
• If no obvious underlying cause –eg surgery / pregnancy /malignancy /immobility
• Look for underlying Ca – Clin
exam ,CXR,PSA,CA125,CEA,Pelvic USS
• Autoantibodies (SLE) – Antinuclear ,Anti- Cardiolipin Ab
• Coagulation factor screen – Antithrombin-3,Protein C/S, Factor 5/8

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11
Q

Coagulation factors

A

Anti-thrombin 3
Protein C/S
Factor 5/8

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12
Q

Prevention of DVT

A

Early post-op mobilisation
• TED compression stockings
• Calf muscle exercises
• Subcutaneous low dose low mol wt heparin perioperatively
• Dabigatran - direct thrombin inhibitor Rivaroxaban/Apixaban - direct inhibitor of
activated factor Xa- both given orally for prophylaxis of venous thromboembolism in adults after hip or knee replacement surgery

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13
Q

Dabigatran

A

Direct thrombin inhibitor

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14
Q

Rivaroxaban/Apixaban

A

Inhibitor of factor Xa

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15
Q

Target range for INR

A

2.5-3.5

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16
Q

How long should a patient continue with warfarin after PE?

A

3-6 months (usually at LEAST 5)

17
Q

lcohol,Antibiotics ,Aspirin,NSAIDs, Amiodarone, Cimetidine,Omeprazole and anticoagulation?

A

lcohol,Antibiotics ,Aspirin,NSAIDs, Amiodarone, Cimetidine,Omeprazole increase anticoagulation?

18
Q

Treatment for PE?

A

Give heparin and continue for 3-5 days (until INR is above 2)
Also give warfarin from the start (as it takes a couple of days to begin to work)
Continue warfarin for at least 5 months
If very bad clot and life threatening e.g. main pulmonary artery occlusion, give thrombolysis (streptokinase or TPA)

19
Q

How to prevent over-anticoagulation?

A

Pro-thrombin complex or fresh frozen plasma
Reverse warfarin with VITAMIN K (especially if liver disease!!)
Reverse heparin with protamine

20
Q

How to reverse heparin?

A

Protamine

21
Q

How to reverse warfarin?

A

Vitamin K

22
Q

Cromones

A

e.g. Cromoglycate
Only used in asthma
Mast cell stabiliser
(good in atopic children - exercise induced asthma)

23
Q

Chlorpheniramine?

A

First generation anti-histamine, sedative

24
Q

Omalizumab

A

Anti-IgE

Injection every 2-4 weeks

25
Q

Which type of drug do methylxanthines interact with?

A

P450 drug interactions (erythromycin)

-Methylxanthines have a low therapeutic ratio

26
Q

Rofumilast

A

Anti-inflammatory PDE4 inhibitor

Oral tablet, once daily, COPD only

27
Q

Oral carbocisteine

Erdosteine

A

Mucolytics

28
Q

Antibiotics for COPD exacerbation

A

1st line :Doxyxcycline (covers everything) or Amoxycillin (not cover atypicals)
2nd line : Clarithromycin , Moxifloxacin (also cover atypicals)

29
Q

Treatment for acute asthma

A

Oral prednisolone (or iv hydrocortisone )
• Nebulised high dose salbutamol, ± Neb ipratropium, ± iv aminophylline/magnesium
• 60% O2
• ITU Assisted mecahnical intubated ventilation if falling PaO2 and rising PaCO2
- never use respiratory stimulant

30
Q

Drugs to help you stop smoking?

A

Nicotine

Bupoprion

31
Q

Symptoms of COPD

A
Exertional breathlessness
Chronic cough
Regular sputum producton
Frequent winter 'bronchitis'
Wheeze
32
Q

Drugs that interact with theophylline?

A

Macrolide and fluoroquinolone antibiotics

33
Q

Effect of PDE4 inhibitors on FEV1? (e.g. rofumilast)

A

Effect on FEV1 is miimal, these drugs have an anti-inflammatory action

34
Q

Which receptor do anti-cholinergics work on?

A

M3