MaM Paper 10 Flashcards
When should a STEMI patient considered for PCI
If they have present within 12 hours of symptoms onset
AND
If they can receive PCI within 2 hours
Which of the following findings would distinguish NSTEMI from unstable angina pectoris?
A)Dynamic T Wave Inversion
B)Response to GTN Spray
C)Elevated Troponin Concentration
D)Elevated BNP
E)New Left Bundle Branch Block
C)Elevated Troponin Concentration
The first-line investigation in suspected ACS is an ECG, and if the patient has ST elevation or a new-onset left bundle branch block, they should be treated as a STEMI with urgent PCI or thrombolysis. If these specific ECG changes are not present, their troponin concentration will help distinguish an infarct (i.e. tissue death in NSTEMI) from ischaemia (i.e. tissue hypoxia in unstable angina). Patients with an NSTEMI or unstable angina may both have ischaemic changes on their ECG (e.g. ST depression or dynamic T wave inversion), however, only an NSTEMI would cause a rise in serum troponin concentration
Triple therapy for eradication of H. pylori
Omeprazole, Metronidazole and Amoxicillin
Murmur Aortic Stenosis
Systolic Murmur
Mitral Regurgitation
Systolic Murmur
Heard best at the apex of the heart with radiation to the left axilla
Mitral Stenosis
Diastolic Murmur
low-pitched, rumbling, mid-diastolic murmur heard loudest over the apex.
Aortic Regurgitation
Diastolic Murmur
A decrescendo blowing diastolic murmur heard best at the left lower sternal border,
How to differentiate right and left sided murmurs?
The key to distinguishing left and right-sided heart murmurs is whether it is louder on inspiration or expiration.
Blood goes in to the right side of the heart so it is louder on inspiration.
Blood exits the left side of the heart so it is louder on expiration.
Meckel’s diverticulum Imaging
CT Scan or Scintigraphy
PSC antiobody
pANCA
Pancreatic cancer
CA19-9
Autoimmune hepatitis antibody
Anti-smooth muscle antibodies (ASMA)
CSF TB
- Raised protein concentration,
- High lymphocyte count
- Low glucose concentration
Viral Meningitis CSF
-Normal / High protein concentration
- High lymphocyte count.
- CSF glucose is not usually low.
Bacterial Meningitis CSF
- Turbid CSF
- High neutrophil count
- Low CSF glucose
WHat virus causes Herpes ZOster Opthalmicus?
VZV
Amandtadine what is it used for?
Parkinson’s medication and anti-viral for Influenza A
Which ECG changes would be suggestive of right heart strain secondary to a pulmonary embolism
T Wave Inversion in V1-3
Treatment for unstable patient with PE?
Alteplase
A 43-year-old woman is brought to A&E by her partner. She complains of generalised abdominal pain and vomiting but thinks that it is most likely due to constipation. She has requested laxatives from the nurses in the department.
She adds that she has had several episodes of upper abdominal pain in the past year which have resolved spontaneously after a few hours or days. She has not sought medical attention for these episodes as they always seem to go away by themselves.
She has not opened her bowels in 3 days and, on examination, her abdomen is significantly distended with a tympanic percussion note. An abdominal X-ray reveals distended loops of bowel with visible valvulae conniventes. She has never had any abdominal operations in the past.
What is the most likely diagnosis in this patient?A)Gallstone Ileus
B)Sigmoid Volvulus
C)Cholecystitis
D)Inguinal Hernia
E)Pancreatitis
A)Gallstone Ileus
Smith fracture
Fractured right distal radius with volar displacement of the fractured fragment
Colles fracture
A distal radius fracture with dorsal displacement of the distal fracture component is referred to as a Colles fracture. It is usually sustained following a fall on an outstretched hand
Management of a Smith Facture
Reduction with analgesia/anaesthetic support is the mainstay of initial management, followed by immobilisation of the joint with a back slab and plaster of Paris.
Colles fracture
A distal radial fracture is termed Colles fracture if the fractured fragment is displaced dorsally. It is commonly accompanied with an ulnar stylus fracture.
