Medicine 1 Flashcards by M H

What features do you see in bifascicular block?

RBBB+LAD

How well did you know this?

Not at all

Perfectly

What features do you see in trifascicular block?

RBBB+LAFB+1st degree AV block

How well did you know this?

Not at all

Perfectly

What is the difference seen on ECG with AVRT and AVNRT and explain how this occures?

AVRT-may see p wave
AVNRT-p wave buried in QRS

accessory pathway in AVRT can be located anywhere, whereas in AVNRT, it is located in the node (where atria and ventricles contract simultaneously)

How well did you know this?

Not at all

Perfectly

What are the 4 treatments for AVRT/AVNRT?

radiocatheter ablation
vagal manouveres
medication
cardioversion

How well did you know this?

Not at all

Perfectly

When is VT more likely compared to SVT with BBB?

Hx of MI

How well did you know this?

Not at all

Perfectly

Name a cause of RVH.

cor pulmonale

How well did you know this?

Not at all

Perfectly

Name 4 causes of LVH.

HTN
CoA
H(O)CM
AS

How well did you know this?

Not at all

Perfectly

What are 2 features on ECG of brugada syndrome?

RBBB+ST elevation in V1-V3

genetic abnormality of heart conduction

How well did you know this?

Not at all

Perfectly

What are the 3 signs of PE on ECG?

S1-deep s wave in lead 1
Q3-q wave in lead 3
T3-T wave inversion in lead 3

How well did you know this?

Not at all

Perfectly

Name the 4 ECG changes in hyperkalaemia.

tall tented T waves
widened QRS
Flattened/absent P waves
sinusoidal

How well did you know this?

Not at all

Perfectly

Name 4 features of hypokalaemia on ECG.

flatted T waves
ST depression
Prolonged QT
Prominent U wave

How well did you know this?

Not at all

Perfectly

Name 5 causes of bradycardia.

DIVISIONS
D-drugs (antiarrhythmics, digoxin, B blocker, Ca2+ blocker)
Ischaemia/infarction
V-
Infection (IE, rheumatic fever, viral myocarditis)
Sick sinus syndrome
Infiltration (AI, sarcoid, haemochromatosis, muscular dystrophy)
O-hypOthyroid, hypOkalaemia (and hyper), hypOthermia
N-neuro (inc ICP)
Surgery/catheterisation

How well did you know this?

Not at all

Perfectly

When do you NOT treat bradycardias? 2 things.

Asymptomatic

>40bpm

How well did you know this?

Not at all

Perfectly

Name 4 indications of pacemakers.

AV block
Mobitz type 2
Sick sinus
AF

How well did you know this?

Not at all

Perfectly

Name 3 mx steps of symptomatic bradycardia <40bpm.

1) rx underlying cause
2) atropine (500mcg up to 3mg) or isoprenaline
3) External pacing (e.g. transcutanous>transvenous)

How well did you know this?

Not at all

Perfectly

When should you avoid using adenosine to revert AF and why?

What 2 things can be used instead?

If the patient has AF+WPW as they may go into VF

Amiodarone or fleicanide

How well did you know this?

Not at all

Perfectly

What doses do you give adenosine in tachyarrhythmias after attempting vagal manouveres?

6mg, 12mg, 12mg

How well did you know this?

Not at all

Perfectly

If there are no adverse signs in a tachyarrhythmia, what 4 options of drug treatment can be given?

Calcium channel blocker (verapimil)
B blocker (atenolol)
Digoxin
Amiodarone

How well did you know this?

Not at all

Perfectly

If a patient with a tachyarrythmia has adverse signs/haemodynamically compromised, what should you do? Give doses etc.

synchronised cardioversion (100j, 200j, 360)
Amiodarone (300mg over 1 hour then 900mg over 23hours)

How well did you know this?

Not at all

Perfectly

Which patient group should you be careful with when giving adenosine?

asthmatics

How well did you know this?

Not at all

Perfectly

Name 5 examples of narrow complex tachys.

sinus tachy
AF
Atrial flutter
Atrial tachy
AVRT
AVNRT

How well did you know this?

Not at all

Perfectly

Name 3 examples of broad complex tachys.

VT
SVT with BBB
Torsades de pointes

How well did you know this?

Not at all

Perfectly

Which 2 antiarrythmic drugs should not be given together and why?

b blocker and Ca2+ channel blocker due to risk of bradycardia.

How well did you know this?

Not at all

Perfectly

Name 4 causes of AF.

HTN
IHD
Rheumatic fever
thyrotoxicosis

How well did you know this?

Not at all

Perfectly

What is rombergs test?

patient stands with eyes closed-test of proprioception to see if they can stay balanced

What is multiple endocrine neoplasia type 1?

Tumours of endocrine glands-pituitary (GH/prolactin), pancreas (insulinoma/gastrinoma), parathyroid

What is multiple endocrine neoplasia type 2?

Endocrine tumour: - thyroid - adrenal pheochromocytoma

What is zollinger ellison syndrome?

excessive levels of gastrin from tumours of duodenum or pancreas

What is the preferred rx for rate control of AF in patients with HF?

digoxin

What is the name of the pupil response seen in a relative afferent pupillary defect?

Marcus Gunn pupil

What is a hutchinsons pupil?

unilateral dilated pupil unresponsive to light-a result of compression of the occulomotor nerve

What do you call bilaterally small pupils that accomodate but don't react to bright light? Seen in diabetes

argyll robertson pupil ARP, PRA Accommodation reflex present BUT pupillary reflex absent

Name a main feature of: a) amyotrophic lateral sclerosis b) primary lateral sclerosis c) progressive muscular atrophy d) progressive bulbar palsy

a) LMN signs in arms UMN signs in legs b) UMN signs only c) LMN signs only, distal>proximal, BEST prognosis d) palsy of tongue/muscles of chewing and swallowing-WORST prognosis

What is: a) peri umbilical bruising b) flank bruising called?

a) cullens | b) grey-turner's

Which ulcer is painful and with painless in syphilis vs herpes?

Painless-syphilis | Painful-herpes

What 2 diseases does the NAAT check?

chlamydia | gonorrhoea

What is advised in a pregnant woman who has a primary attack of herpes at greater than 28 weeks gestation?

C-section

What assessment tool is used to measure fracture risk? If there is a significant result, what test should be done next? What is the equivalent measure of cardiovascular event risk?

FRAX- fracture risk assessment tool. Then do DEXA scan (bone mineral density scan) QRISK score

Name the 5 steps in newborn resuscitation.

1) DRY baby, maintain temp 2) Assess tone, breathing, heart rate 3) If not breathing, open airway and give 5 inflation breaths 4) If HR undetectable start CPR at rate of 3 compressions to 1 breath (3:1) 5) Reassess HR every 30 secs and if still undetectable, consider IV access

Name the test used to detect a meniscal injury and 3 signs/symptoms seen.

``` Mcmurrays test Pain worse on straightening knee May feel knee locking Knee 'gives way' Tenderness along joint line ```

Which haematoma do patients experience a lucid interval?

extradural-patient appears to improve for a few days and then deteriorate suddenly

Name 2 features of subdural haematoma.

occurs in older age, alcoholism, anticoagulation | fluctuating confusion/consciousness

Which haematoma results in sudden worse headache, usually due to a ruptured aneurysm or following trauma?

SAH

What is the most common symptom seen in PE?

tachypnoea!

What must you test before giving someone amiodarone?

TFT

What is the triad of symptoms seen in normal pressure hydrocephalus?

dementia disturbed gait incontinence

What is the first line ix in hydrocephalus?

CT head

What ix must NOT be done in obstructive hydrocephalus and why?

LP-difference in cranial and spinal pressures will cause brain herniation

Name 3 features of lewy body dementia. | Name 3 drug treatments.

dementia+progressive cognitive impairment visual hallucinations parkinsonism Donepazil, rivastigmine, memantine

In what manner does vascular dementia progress?

step wise manner

What is the triad of things seen in plummer vinson syndrome?

dysphagia oesophageal webs iron deficiency anaemia

What is the first line diagnostic test of oesophageal ca?

upper GI endoscopy

What is the most preferred rx of oesophageal ca and what is a major complication of this?

Ivor Lewis Mediastinitis due to anastamosis being in thorax

Name 4 examples of extra pyramidal side effects. Which drug is used to manage this?

Parkinsonism acute dystonia (torticollis/oculogyric crisis) Tardive dyskinesia Akathisia (severe restlessness) procyclidine

Which antipsychotics cause extra pyramidal side effects? Atypical or typical

typical

What 2 things are the elderly at risk of when taking antipsychotics?

stroke | VTE

Which typical antipsychotic most commonly causes prolonged QT interval?

haloperidol

Unilateral deafness, vertigo and tinnitus in 64y/o pt over past 4 weeks. What is the diagnosis?

acoustic neuroma HOWEVER depending on the CN affected, my get facial palsy (CN7) or absent corneal reflex (CN5)

Bilateral deafness occurs in presbyacusis and otosclerosis-how do you differentiate?

presbyacusis-sensorineural | otosclerosis-conductive

What is the ix of choice to diagnose acoustic neuroma/vestibular schwannoma?

MRI cerebellopontine angle

What rare autosomal dominant genetic disorder leads to abnormal vessel formation in skin and mucous membranes, causing nosebleeds and GI bleeding?

hereditary haemorrhagic telangiectasia

What abx is used to treat animal bites?

co-amoxiclav

What is another name for lateral epicondylitis? When is pain the worst? What are 3 rx options?

tennis elbow Wrist extension against resistance whilst elbow is extended physiotherapy steroid injection simple analgesia

What does CREST syndrome stand for?

``` Calcinosis Raynauds Esophageal dysnfunction Sclerodactyly (tightening of skin around fingers and hands) Telangiectasia ```

What is achalasia?

causes oesophageal dysfunction and LOS does not allow food into stomach

Which patient group should not receive cyclizine as an anti emetic and why?

HF-cyclizine causes reduced cardiac output and inc HR

Which anti emetic should be avoided in intestinal obstruction?

metoclopramide as pro kinetic

What happens to a thyroid swelling when you swallow?

moves upwards

What movement makes a thyroglossal cyst move? Which age group is it most common in?

protrude tongue | most common in <20years old

Name 3 symptoms experienced with a pharyngeal pouch (oesophageal herniation between 2 muscles).

dysphagia regurgitation aspiration

What is the name of the neck lump that is fluid filled and present at birth, found in post triangle and transilluminates.?

cystic hygroma

What cyst is found between SCM and pharynx and usually presents in early adulthood?

branchial cyst

What is the name of the pulsating neck mass that doesn't move on swallowing?

carotid aneurysm

which condition has bi-basal fine end-inspiratory creps on auscultation, as well as exertional dyspnea, dry cough and clubbing?

idiopathic pulm fibrosis

What are the 3 rx of idio pulm fibrosis?

lung rehab oxygen lung transplant

If a patient progresses from having decorticate to decerebrate herniation, what may have caused this?

tonsillar/uncal herniation (coning)

What is the first line management of mastitis?

continue breastfeeding with non infected side and express to empty breast (prevent abscess formation) and give antibiotics