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E-Lectures and Live Lectures Year 3 Medicine > Live Lecture - Cases > Flashcards

Live Lecture - Cases Flashcards

1
Q

50 year old man with chest pain. When he climbs the hill to go to Tesco he gets a severe tightness in his chest. When he rests it goes away. What is the next test that should be done.

A

ECG.

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2
Q

50 year old man with chest pain. When he climbs the hill to go to Tesco he gets a severe tightness in his chest. When he rests it goes away. His ECG on rest is normal, with a pulse rate of 99BPM. What is the next test.

A

Exercise ECG.

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3
Q

50 year old man with chest pain. When he climbs the hill to go to Tesco he gets a severe tightness in his chest. When he rests it goes away. His ECG on rest is normal.
His exercise ECG shows a pulse rate of 150BPM and ST depression.
What is the most likely diagnosis.

A

Chronic stable angina.

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4
Q

What is chronic stable angina caused by.

A

Partially blocked coronary artery.

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5
Q

What are the symptoms of angina due to.

A

When the heart rate rises, the ischaemic in the heart becomes significant. The lactate will accumulate causing pain.

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6
Q

What is the clinical sign seen on ECG in chronic stable angina.

A

ST depression.

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7
Q

What drugs are used to treat chronic stable angina. (4)

A

Beta blockers (atenolol).
Aspirin.
Glyceryl trinitrate (also isosorbide mononitrate ISMN can be used).
Simvastatin.

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8
Q

What are the surgical treatment options for chronic stable angina.

A

CABG (in the old days).
Angiogram to see where the block is.
Angioplasty to open up the coronary vessel.

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9
Q

What is the best first line treatment for STEMI.

A

Primary angioplasty if you can get it quickly.

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10
Q

What treatment should you get done if you have a STEMI and cannot get a primary angioplasty quickly.

A

Thrombolysis.

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11
Q

What causes the first heart sound (S1).

A

Closure of mitral valve.

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12
Q

What kind of MI carries a worse prognosis.

A

Anterior MI.

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13
Q

What kind of MI carries a good prognosis.

A

Inferior MI.

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14
Q

What is the name of the valve that cause the first part of the second heart sound (S2).

A

Aortic valve.

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15
Q

What is the name of the valve that cause the second part of the second heart sound (S2).

A

Pulmonary valve.

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16
Q

A patient comes into AandE with a diagnosis of an acute MI. What blood tests will confirm this diagnosis. (4)

A 
Troponins. 
Creatine Kinase. 
AST.
LDH.
(from best test to worst)
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17
Q

What is the likely cause of an S3 in a 63 year old man who comes to AandE.

A

S3 is usually the first sign of heart failure. (usually even before the patient has realized).

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18
Q

A 64 year old man comes to AandE with what appears to be an S4. What is the likely diagnosis.

A

Usually caused by long term hypertension.

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19
Q

What is S3 caused by.

A

It is caused by rapid ventricular filling.

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20
Q

What is S4 caused by.

A

Atrial contraction against a stiff ventricle.

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21
Q

A 65 year old man turns up to AandE and you hear a decrescendo murmur after S2. What is it called.

A

Aortic regurgitation.

22
Q

What sort of murmur is aortic regurgitation.

A

It is an early diastolic murmur.

23
Q

What other physical signs are you likely to find in a patient presenting with aortic regurgitation.

A

Quinke’s sign.

24
Q

What sort of pulse do you get in aortic regurgitation.

A

A collapsing pulse.

25
Q

What is the likely systolic BP in a patient with aortic regurgitation.

A

It will be higher than normal, for example 220.

As the heart is pumping against a lot of pressure.

26
Q

What is the likely diastolic BP in a patient with aortic regurgitation.

A

It will be lower than normal, for example 40.

As the blood leaks back after systole back into the heart due to the incompetent valve.

27
Q

What is the sign involving the pulse pressure for aortic regurgitation.

A

A wide pulse pressure.

28
Q

How is the circulation of aortic regurgitation described.

A

Dynamic.

29
Q

How do you check for aortic regurgitation.

A

Check for a collapsing pulse.

30
Q

What is Quinke’s sign.

A

Pulsation of the nail bed.

31
Q

What does Quinke’s sign indicate.

A

A wide pulse pressure, indicative of aortic regurgitation.

32
Q

What is the test indicated for a patient presenting with aortic regurgitation.

A

Echo.

33
Q

How do you ideally want to treat aortic regurgitation.

A

Valve replacement.

34
Q

All patients must be asked whether or not they have had a past history of acute rheumatic fever. True or false.

A

True.

35
Q

Acute rheumatic fever is caused by a bacterial infection of the heart. True or false.

A

Yes

36
Q

Acute rheumatic fever is an autoimmune disease. True or false.

A

Yes

37
Q

What is acute rheumatic fever associated with.

A

It is always associated with group A haemolytic streptococcal infections.

38
Q

Acute rheumatic fever is only associated with _____

A

pharyngeal infections

39
Q

When does the initial infection with group A strep infection (which later leads to develop rheumatic fever) usually occur

A

In childhood

40
Q

What is the genetic association with developing rheumatic fever.

A

HLA class 2 alleles.

41
Q

What three factors predispose a person to developing rheumatic fever later on in life.

A

A severe initial infection.
A large immune response.
A positive family history.

42
Q

Will all patients who contract a group A strep infection go on to develop rheumatic fever.

A

No, only a very small proportion will.

43
Q

What factors predispose to developing a group A beta-haemolytic streptococcus infection. (3)

A

Age 4-10.
Females more likely than males.
Winter.
Lower socioeconomic background (unable to afford antibiotics in the 60s)

44
Q

What antibodies do patients with rheumatic fever develop.

A

antibodies to M protein. (if severe infection)

45
Q

What problem is there with developing M protein antibodies.

A

They also bind to heart muscle. (molecular mimicry by the bacteria)

46
Q

What is the pathogenesis of acute rheumatic fever. (2)

A

It is likely to be an autoimmune disease.

Generated through molecular mimicry.

47
Q

What do you see in acute rheumatic fever. (2)

A

Damaged heart muscle.

Sydenham’s chorea.

48
Q

What is sydenham’s chorea.

A 
Movement disorder (irregular, abrupt, relatively rapid involuntary movement).
Emotional and behavioral disturbances (OCD behaviour, frequent mood changes and emotional lability).
49
Q

What movements do you get with sydenham’s chorea. (4)

A

irregular, abrupt, relatively rapid involuntary movement

50
Q

What behavioural disturbances do you see with sydenham’s chorea. (3)

A

OCD behaviour, frequent mood changes and emotional lability

51
Q

What are the physical signs of acute rheumatic fever. (5)

A 
Pancarditis.
Arthritis.
Movement disorder (sydenham's chorea).
Rash.
Nodules on elbows.
52
Q

What part of the brain do the antibodies developed for rheumatic fever affect.

A

Basal ganglia.

E-Lectures and Live Lectures Year 3 Medicine (3 decks)

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