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Medicine and Surgery > Medicine > Flashcards

Medicine Flashcards

1
Q

Asthma Rx Step 1

A

Inhaled short acting B2 agonist PRN eg. salbutamol

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2
Q

Asthma Rx Step 2

A

Add inhaled steroid 200-800mcg/day eg. BECLAMETASONE (Fluticasone longer acting) 400mcg is appropriate starting dose

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3
Q

Asthma Rx Step 3

A
  1. Add inhaled LAB2 Agonist (LABA) eg. SALMETEROL 2. Assess control of asthma: -good response to LABA: continue -Benefit from LABA but control still inadequate:continue LABA and increased inhaled steroid to 800 - No response to LABA: stop LABA, increase steroids to 800mcg. If still inadequate trial other therapies eg. leukotriene R ANT eg. MONTELEUKAST or Sustained Release Theophylline
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4
Q

Asthma Rx step 4

A

Consider trials of: 1. Increasing inhaled steroid upto 200mcg/day 2. Add a 4th drug: eg. Leukotriene R ANT (MONTELEUKAST), sustained release theophylline, B2 Agonist tablet.

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5
Q

Asthma Rx step 5

A

Use daily steroid tablet in lowest dose. maintain inhaled steroid at 2000mcg Refer for specialist care.

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6
Q

Leukotriene R ANT

A

MONTELEUKAST or ZAFIRLUKAST -antiinflam and bronchdilatory. used whe pts poorly controlled on high dose inhaled steroids and and a LABA. -useful in ASPIRIN induced asthma -associated with development of churg-strauss- Vasculitis + airway atopy. (vasculitis-eosinophilic granulomatosis with polyangitis)

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7
Q

FLUTICASONE

A

Inhaled steroid for asthma. Longer acting than Beclametasone.

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8
Q

Diseases causing Obstructive Lung Disease

A

Asthma COPD Bronchiectasis Bronchiolitis Obliterans

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9
Q

PFTs in Obstructuve Lung disease FEV1 - FVC - FEV1:FVC -

A

FEV1 - significantly reduced FVC - reduced or normal FEV1:FVC - reduced

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10
Q

Diseases causing restrictive Lung disease

A

Pulmonary Fibrosis Asbestosis Sarcoidosis ARDS Kyphoscoliosis Neuromuscular Disorders

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11
Q

PFTs in Restrictive Lung Disease FEV1 - FVC - FEV1:FVC -

A

FEV1 - reduced FVC - significantly reduced FEV1:FVC - normal and increased

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12
Q

Stage 1 HTN criteria

A

Clinic BP >140/90 AND ABPM average >135/85

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13
Q

Management of stage 1 HTN: with low CV risk

A

BP >140/90 but CV risk is low Offer ABPM Lifestyle changes 1. Cut salt intake. can drop by up to 10mmHg 2. Eat a healthy, low fat diet 3. quit smoking 4. Exercise 5. Cut down on caffeine

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14
Q

Risk associated with increasing BP

A

every 2mmHg –> 7% increase of mortality from IHD 10% increased mortality from stroke

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15
Q

Stage 2 HTN criteria

A

Clinic BP >160/100 AND ABPM average >150/95 (from at least 14 measurements)

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16
Q

Severe HTN criteria

A

>180mmHg systolic OR >110mmHg diastolic

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17
Q

Management of severe HTN

A

BP >180/>110 - immediate Rx considered - signs of papilloedema or retinal heamorrhage –> same day by specialist -

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18
Q

When to treat stage 1 HTN

A

BP >135/85 AND any 1… - 10 years

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19
Q

fasting plasma glucose 6.2mmol/L

A

Impaired fasting glycaemia. 6.1-6.9 mmol/L Prediabetes

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20
Q

diagnosis of diabetes via one of 2 tests. these tests are…

A

HbA1c Plasma glucose

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21
Q

Diagnosis of diabetes in symptomatic patient

A

-Symptomatic -fasting glucose >7 -Random/OGTT glucose >11.1

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22
Q

Diagnosis of diabetes in asymptomatic patient.

A

-As per symptomatic but on 2 separate occasions. -fasting glucose >7 -Random/OGTT glucose >11.1

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23
Q

HbA1c in diabetes

A

>6.5% (48mmol/mol)

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24
Q

things that mislead HbA1c results

A
  • Hbopathies - Haemolytic anaemia - untreated IDA - suspected GDM - Children - HIV - CKD
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25
Q

what to do with impaired fasting glucose…

A
  • offer OGTT to rule out DM - results 7.8-11.1 = impaired glucose tolerance
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26
Q

CHADSVASC: Anticoagulation Strategy Score 0 Score 1 Score 2

A

0: no treatment 1: M- consider anti-coag F- No Rx >2: Offer anti-coagulation

27
Q

CHADSVASC Scoring

A

C - Congenstive Heart Failure: 1 H - HTN (or treated): 1 As - Age >75: 2 Age 65-74: 1 D - Diabetes S2 - Prior Stroke or TIA: 2 Va - Vascular Disease (IHD, PAD): 1 Sex - female: 1

28
Q

HASBLED scoring

A

H - HTN, uncontrolled, >160mmHg: 1 A - Score 1 for any…. - Abnormal renal function (dialysis/Cr >200) - Abnormal LFTs (Cirrhosis, bilirubin >2 ULN, ALT/AST/ALP > 3ULN) S - Stroke: 1 B - Bleeding, Hx of bleeding, tendency to bleed: 1 L - Labile INR (unstable/high INR, time in therapeautic range 65 years: 1 D - Drugs predisposing to bleeding: score 1 for drugs (antiplatelets/NSAID), 1 for EToH (>8 drinks/week)

29
Q

Causes of bradycardia DIVISIONS

A

Drugs- (ABCD)Antiarrhythmics, Amiodarone, Bblockers, CCBs, Digoxin Ischamia/infarction: inferior MI- heart block Vagal hypertonia: athletes, vasovagal syncope, carotid sinus syndrome Infection: myocarditis, rheumatic fever, IE Sick sinus syndrome: Infiltrative diseases: restrictive/dilated cardiomyopathy O: hypOthyroid, kalaemia, thermia Neuro: raised ICP septal defects Surgery or cardiac catheter.

30
Q

Top 3 causes of bradycardia

A
  1. drugs: antiarrhythmics (type 1), amiodarone, b blockers, ccb, digoxin 2. Infarction/ischaemia: heart block 3. Hypothyroidism
31
Q

Heart block types

A

1st degree: PR>200ms 2nd degree: mobitz 1-wenkebach Mobitz 2 Complete heart block: - junctional escape rhythm: narrow QRS 50bpm - ventricular escape rhythm: wide QRS 40bpm

32
Q

Treatment for bradycardia: asx and urgent

A

If asx and >40bpm- no Rx <40bpm- URGENT- resus with an ABC approach 1. Manage underlying cause 2. Medical: - atropine IV (0.6-1.2g) —- alkaloid that increases HR - isoprenaline 3. External pacing

33
Q

Elective treatment for bradycardia in which conditions

A

Permanent pacing: - mobitz type II heart block - complete AV block -Sick sinus syndrome - AF - drug resistant tachyarrythmias

34
Q

Management of SVT

A

If pt unstable- sedate and DC cardiovert Pt stable- identify rhythm and treat

35
Q

PRint >200ms Regular rhythm

A

First degree heart block Often asx No Rx

36
Q

Progressive lengthening of PRint One non conducted P wave Next conducted beat short PRint Eg. 5 P waves, 4 QRS- ratio of 5:4

A

2nd degree heart block Wenkebach/mobitz type I Caused by an INFERIOR MI- reversible conduction block at AVN Rx: monitor

37
Q

Constant PRint Occasional non conducted P waves Often wide QRS Constant P wave rate Conduction ratio van be variable

A

2nd degree heartblock mobitz type II Caused by ANTERIOR MI: septal infarction Wide QRS- block is often in bundle branches of purkinje Rx: pacemaker

38
Q

Variable number of P waves per QRS- but always fixed. PRint constant and 120-200ms P wave rate constant QRS rate constant

A

2nd degree fixed ratio heart block 2:1 3:1 4:1 As result of Mobitz I or II - type I: narrow QRS, block at AVN - type II: broad QRS, usually pre-existing BBB

39
Q

Complete dissociation of P waves and QRS complexes p waves constant rate QRS at constant rate Often bradycardic (ventricular escape rhythm of 40bpm)

A

3rd degree heart block End point of Mobitz type I or II AV block Caused by INFERIOR MI High risk of sudden cardiac death Rx: pacemaker

40
Q

Wide QRS rSR in V1-v3 qRs in V6- slurred S wave in lateral leads Tinv in right sided leads (abnormal repolarisation)

A

Right bundle branch block MaRRoW Aetiology:INCH - Inferior Mi - Congenital: ASD, VSD, Fallot - Hypertrophy: RVH (PE, Cor pulmonale)

41
Q

Wide QRS Loss of Q waves laterally (Q waves are normal septal depol) Tall R waves in lateral leads Deep S waves v1 (v1-3) M shaped R wave in lateral leads ST segment and T waves opposite direction to QRS vector

A

Left bundle branch block Usually always in presence of organic disease Causes: FLIC -Fibrosis -LVH: AS, htn -Inferior infarction -Coronary heart disease

42
Q

RBBB plus LAD

A

Bifascicular block Extensive conducting system disease-

43
Q

RBBB + L?anterior fascicle block + first degree AV block

A

Trifascicular block

44
Q

Type of Escape rhythm SAN fails to depolarise…. Abnormal P wave Normal QRs 60-80bpm

A

Atrial escape

45
Q

Type of escape rhythm Usually no P waves (occasionally after QRS) Normal QRS 40-60bpm

A

Junctional escape rhythm

46
Q

Type of escape rhythm Usually as a result of complete AV block- See regular p waves If SAN failure- no P waves Wide QRS 20bpm

A

Ventricular escape rhythm

47
Q

These are all types of what?… AVNRT AVRT Atrial Tachycardia Atrial Flutter Atrial fibrillation

A

Narrow complex tachycardia

48
Q

Tachycardia P wave absent or immediately before/after QRS QRS normal (<120ms)

A

AV nodal Re-entrant Tachycardia - re-entry of depolarisation into the SAN via long and short pathways

49
Q

S1Q3T3 Deep s wave in 1 Pathological Q wave in III Tinv in III

A

PE

50
Q

Delta wave

A

Wpw

51
Q

Down sloping ST segment (reverse tick) Tinv

A

Digoxin

52
Q

Wide QRS No P waves Sine wave appearance bradycardia

A

Hyperkalaemia

53
Q

Small T waves ST depression Prolonged QTint U waves

A

Hypokalaemia

54
Q

Lichen Planus: Ps

A

Planus: ?AI Purple Pruritic Papular Polygonal Flexor surfaces (palms, soles, genitals) Wickhams striae on surface Oral involvement common Koebner Phenomenon (new lesions at trauma site)

55
Q
  1. Name the rash
  2. describe the rash
  3. causes of the rash
  4. treatment
A
  1. Lichen planus
  2. purple, pruritic, papular, polygonal rash on flexor surfaces. Commonly oral.
  3. ?Autoimmune, quinine, thiazides
  4. topical steroids (severe- immunosuppression)
56
Q

Joint most commonly affected by gout

A

first metatarsal-phalangeal joint

57
Q

Microcystal synovitis: monosodium urate monohydrate crystals in the synovium

  1. what is it?
  2. which joint likely affected?
  3. risk factors?
  4. management- acute and chronic
A
  1. Gout
  2. first metatarsal-phalangeal joint
  3. RF:alcohol, obesity, foods high in purine (liver, kidney, oily fish, red wine, cheese
  4. Acute: NSAIDS, ateroid injection, colchicine slow onset of action. If above CI use low dose pred (15mg/day), allopurinol if pt already on it
  5. Chronic: Lifestyle modification, Allopurinol Prophylaxis (2 weeks after acute attack)
58
Q

Indications and instructions for starting Allopurinol in Gout

A

Indications:

  1. Recurrent attacks (>2 in 1 year)
  2. Tophi
  3. renal disease
  4. uric acid renal stones
  5. prophylaxis if on cytotoxics or diuretics

Instructions:

2 weeks post acute attack. Before then may precipitate another acute attack.

  • Titrate dose to serum uric acid
  • cover with NSAID or cochicine whilst starting
59
Q

Cystic Fibrosis

  1. Mode of inhertitence
  2. chromsome number
  3. Mutation in…
  4. clinical manifestations
  5. complications
  6. treatment
A
  1. AR
  2. 7
  3. CFTR (cystic fibrosis transmembrane receptor
  4. Lungs- chronic infections esp Pseudomonas Aeroginosa, bronchiectasis. Digestive- meconium ileus, pancreatic insufficiency, FTT, repro- male infertility
  5. life expectancy 35yrs, death by end stage lung disease
  6. supportive via MDT, chest physio, mucolytics, Abx for Cx infx, pancreatic enzyme replacement (creon), heart-lung transplant.
60
Q

7 diagnostic criteria of rheumatoid arthritis

A

Only need 4 for a diagnosis:

  1. morning stiffness for >1h for >6/52
  2. Arthritis in >3 joints
  3. Arthritis of hand joints
  4. Symmetrical
  5. Rheumatoid Nodules
  6. +ve Rheuamtoid factor
  7. Radiographic changes
61
Q

radiological changes in rheumatoid arthritis

A
  1. juxtaarticular osteopenia
  2. soft tissue swelling
  3. loss of joint space
  4. advanced:
    1. bony erosions
    2. subluxation
62
Q

Neurtropenia + Rheumatoid Arthritis + Splenomegaly

A

FELTYS SYNDROME

63
Q
A

Medicine and Surgery (6 decks)

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