Meeran Lectures Notes Flashcards
What is Acute Rheumatic Fever
Immune response to strep pyogenes
What is chronic rheumatic heart disease
20years after Rheumatic fever
fibrosis of heart valves - MS, AR
infective endocarditis
IVDU or people who have a damaged heart valve liklely to get it
Ix in Rheumatic Fever
High ASO
positive throat culture
What are the major criteria for rheumatic fever
Carditis
Arthritis
Nodules
Erythema Marginatum
Random Movement - Sydenham Chorea
What signs will you see in Mitral stenosis
Malar Flush
AF
Tapping Apex
Non displaced apex
Right ventricular heave
Blowing mid diastolic murmur and presystolic accentuation
Mitral Regurg signs
Displaced apex
Apical thrill
Quiet S1
Pansystolic murmur radiating to axilla
S3 present - rapid ventricular filling
What is a valvotomy
seen in pts with MS - opened up to leave MR
Aortic regurg signs
Collapsing pulse
Wide PP
Corrigans Neck
Quinckes fingers
Dynamic apex
EDM heart LSE
Systolic flow murmur
Causes of AR
Old syphilis
Marfans
Ank Spond
Reiters
ECG - significnace of Q wave
Dead myocardium - full thickness
Takes 4 hours
Deep - won’t recover like T waves will
Consider reperfusion injury through VF
NYHC 1+2
give BB
S3
rapid ventricular filling
Kentucky
S4
Atria contracting against stiff ventricle
HTN or AS
Ten-nes- see
Rx of cardiogenic shock
B1 agonist like dobutamine
effect to stimulate heart muscle to work harder
Also balloon pump in aorta to relieve load
Sign of cardiogenic shock
Raised JVP
Cold and clammy peripheries
Hypotensive
What is the effect of dopamine in Low, medium and high doses
Low - improves renal perfusion
Medium - Beta 1 Cardiac Agonist (cardiogenic shock)
High - not used by Alpha 1 agonist and peripheral vasoconstriction
How to locate the apex beat
Most LATERAl and INFERIOR
What DISPLACES the apex beat?
Dilatation
What causes cardiac dilatation
VOLUME OVERLOAD
AR
HF
MR
ASD/VSD
What causes HYPERTROPHY
PRESSURE OVERLOAD
AS
HTN
CoArc Aorta
Non Q waves in MI ECG
Subendocardial MI
When is MI reversible
If ST elevation seen in 4 -12 hours
When are Q waves irreversible after
6 hours
Ix in Penumonia
Sputum Sample/culture
Lateral vie Chest Xray
Bloods
Xray in 6 weeks to ensure its cleared and no underlying pathology
Mx of simple pneumothorax
Can leave it
Why should you drain a tension penumothorax
Pinches on OVC and SVC so reduced CO
What is asthma
Reversible airway obstruction
What is emphysema
Irreversible airways obstruction
What is a normal FEV1
75% of FVC
Acute severe asthma RX
Oxygen
5mg Salbutamol and oxygen
Steroids 100mg IV Hydrocortisone
40mg Pred )D
If asthma is severe
Transfer to ITU
Aminophylline 100-200mg slow IV
Ventilate
MgSo4 - risk of arrhythmias
asthma what is paradox breathing
greater than 20mmHg difference in pressure on breathing. Measure with a cuff and see the dial moving
IN COPD what oxygen should be given
If O2 and Co2 both 7
give venturi 24%
If Co2 climbs give NIV to get rid of Co2.
Turn off NIV when the infection clears and things return to normal
Chronic Liver Disease signs
Spider Navi >5
Clubbing
Palmer Erythema
Duypytrens
Gynaecomastia
Testicular atrophy
Liver Cell Failure
Jaundice
Leuconychia
Bruising
Ascites
Encephalopathy
Signs of Portal hypertension
Splenomegaly
Ascites
Dilated veins on abdomen
Haematemesis and melaena
With dilated abdo veins how to tell of portal hypertension or IVC obstruciton
Direction of the vein inferior to umbilicus
Portal Hypertension - blood flow away from umbilicus
IVC obstruction - towards the umbilicus
Signs in Cholestasis
Excoriations
Pale stools
Dark urine - negative for urobilinogen
jaundice
Xanthelasma
How to copare kidney and spleen in RIF
Kidney moves to RIF and down
Spleen (CML) - from left down to right
Kidney is resonant
Spleen is dull
Rise above the kidney and not the spleen
Types of Erythema
Migratory Necrolytic Erythema
Chronicum Migrans
Marginatum
Ab igne
Multiforme
Nodosum
Necrolytic migratory erythema associated with
Glucagonoma
Chronic Migrans seen in
Lyme Disease
Marginatum seen in
Acute Rheumatic fever
Erythema Ab Igne seen in
Hotwater bottle
Erythema multiforme
Target lesions SJS
Nodosum seen in
variety
IBD
Sarcoid
Cnacer
dRUGS
Infections
Action of Insulin
movement of Glut 4 to cell surface and movement of K+ and phosphate into cells
Stimulates fat generation
In DKA what is treatment
Fluid
Insulin
Potassium
If pH is less than 7 have to give small amoun of bicarb as insulin doesnt work in that low pH
Third nerve palsy with large pupil
COMPLETE third nerve palsy
Surgical Third nerve palsy
Pupil is not spared
seen in Posterior communicating aneurysm
Pressure on nerve
Why is it important to treat a squint in young
At birth the brain hasn’t developed the macula - if an image doesnt fall on the eye
get
AMBLIOPIA
from lack of developement
Squint causes
Muscle weakness or strabismus (squint)
Why do a cover test in a patient with a squint?
It proves that the 6th nerve (Abducting the eye) is working so no 6th nerve palsy present
If patient states see double vision what should you do?
Work out which is the weak eye
Weak eye is responsible for the outer most image
Causes of Unilateral Exopthalmos
Graves
Peri-orbital Cellulitis
trauma
Causes of Complex othalmoplegia
Graves
Myathenic Gravis
Retro-orbital tumour
Miller-Fischer Syndrome
Stages of diabetic retinopathy
Background
Pre-proliferative
Proliferative
Diabetic maculopathy
Signs of Background retinopathy
hard exudates
Microaneurysm
Blot Haemorrhages
Rx of background retinopathy
Improved control of DM - metformin
What do cotton wool spots indicate?
retinal ischaemia
Pre-proliferative stage
Cotton wool (ischamia)
Silver wiring and flame haemorrhages as thin walled vessels
rx of cotton wool
Require laser tx to stop new vessel formation
Old - dark
new - bright
Laser rx can be mistaken for what?
Retinitus Pigmentosa
which is spicular
Dominant condition which can also occur by itself
What is Horners
Damage to the sympathetic chain
Ix in Horners
X-ray for possible lung tumour
Signs of hypertensive retinopathy
- Silver wiring
- AV nipping
- Cotton wool spots and flame haemorrhages
- Papilloedema
What is homonomous hemianopia
Can’t see one side of vision even with both eyes open
Who gets homonomous hemianopia?
Storke patients
IVDU Cardio complications and Signs
Staph A infection on tricuspid valve
Endocarditis
Signs
Hands - roth spots, janeway lesions, splinter haemorrhages, clubbing, petechiae
Murmur - diastolic murmur
Abdo
- Splenomegaly from active immune with septic emboli
Microscopic haematuria
Malar Flush
Mitral Stenosis
How can MS be heard better
After exercise
Other conditions in MS
Af (50%)
Chest x ray in Mitral stenosis
2 signs to look for
Left atrial enlargement
Pulmonary Haemosiderosis from pHTN
Causes of AF
MS
Thyrotoxicosis
Caffeine/Alcohol
Ischameic Heart Disease
Rheumatic heart disease
Rheumatic Heart disease (common)
PE
Ca bronchus
Rx AF
Rate and Rhythm
rate - BB or digoxin
Rhythm - Amioderone but bad SE
What are the implications of using Digoxin in AF
It locks people into a lower rate
Suitable in people who don’t need their ventricular reserve (old)
After MI if AV node stops working and they have a pulse rate of 30 what needs to happen?
Need PACING
An LV aneurysm will show what on ECG?
ST elevation
What are the signs of heart failure?
