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Lectures final revision > Meeran Lectures Notes > Flashcards

Meeran Lectures Notes Flashcards

1
Q

What is Acute Rheumatic Fever

A

Immune response to strep pyogenes

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2
Q

What is chronic rheumatic heart disease

A

20years after Rheumatic fever

fibrosis of heart valves - MS, AR

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3
Q

infective endocarditis

A

IVDU or people who have a damaged heart valve liklely to get it

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4
Q

Ix in Rheumatic Fever

A

High ASO

positive throat culture

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5
Q

What are the major criteria for rheumatic fever

A

Carditis

Arthritis

Nodules

Erythema Marginatum

Random Movement - Sydenham Chorea

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6
Q

What signs will you see in Mitral stenosis

A

Malar Flush

AF

Tapping Apex

Non displaced apex

Right ventricular heave

Blowing mid diastolic murmur and presystolic accentuation

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7
Q

Mitral Regurg signs

A

Displaced apex

Apical thrill

Quiet S1

Pansystolic murmur radiating to axilla

S3 present - rapid ventricular filling

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8
Q

What is a valvotomy

A

seen in pts with MS - opened up to leave MR

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9
Q

Aortic regurg signs

A

Collapsing pulse

Wide PP

Corrigans Neck

Quinckes fingers

Dynamic apex

EDM heart LSE

Systolic flow murmur

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10
Q

Causes of AR

A

Old syphilis

Marfans

Ank Spond

Reiters

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11
Q

ECG - significnace of Q wave

A

Dead myocardium - full thickness

Takes 4 hours

Deep - won’t recover like T waves will

Consider reperfusion injury through VF

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12
Q

NYHC 1+2

A

give BB

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13
Q

S3

A

rapid ventricular filling

Kentucky

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14
Q

S4

A

Atria contracting against stiff ventricle

HTN or AS

Ten-nes- see

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15
Q

Rx of cardiogenic shock

A

B1 agonist like dobutamine

effect to stimulate heart muscle to work harder

Also balloon pump in aorta to relieve load

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16
Q

Sign of cardiogenic shock

A

Raised JVP

Cold and clammy peripheries

Hypotensive

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17
Q

What is the effect of dopamine in Low, medium and high doses

A

Low - improves renal perfusion

Medium - Beta 1 Cardiac Agonist (cardiogenic shock)

High - not used by Alpha 1 agonist and peripheral vasoconstriction

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18
Q

How to locate the apex beat

A

Most LATERAl and INFERIOR

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19
Q

What DISPLACES the apex beat?

A

Dilatation

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20
Q

What causes cardiac dilatation

A

VOLUME OVERLOAD

AR

HF

MR

ASD/VSD

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21
Q

What causes HYPERTROPHY

A

PRESSURE OVERLOAD

AS

HTN

CoArc Aorta

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22
Q

Non Q waves in MI ECG

A

Subendocardial MI

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23
Q

When is MI reversible

A

If ST elevation seen in 4 -12 hours

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24
Q

When are Q waves irreversible after

A

6 hours

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25
Q

Ix in Penumonia

A

Sputum Sample/culture

Lateral vie Chest Xray

Bloods

Xray in 6 weeks to ensure its cleared and no underlying pathology

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26
Q

Mx of simple pneumothorax

A

Can leave it

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27
Q

Why should you drain a tension penumothorax

A

Pinches on OVC and SVC so reduced CO

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28
Q

What is asthma

A

Reversible airway obstruction

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29
Q

What is emphysema

A

Irreversible airways obstruction

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30
Q

What is a normal FEV1

A

75% of FVC

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31
Q

Acute severe asthma RX

A

Oxygen

5mg Salbutamol and oxygen

Steroids 100mg IV Hydrocortisone

40mg Pred )D

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32
Q

If asthma is severe

A

Transfer to ITU

Aminophylline 100-200mg slow IV

Ventilate

MgSo4 - risk of arrhythmias

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33
Q

asthma what is paradox breathing

A

greater than 20mmHg difference in pressure on breathing. Measure with a cuff and see the dial moving

34
Q

IN COPD what oxygen should be given

A

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

35
Q

Chronic Liver Disease signs

A

Spider Navi >5

Clubbing

Palmer Erythema

Duypytrens

Gynaecomastia

Testicular atrophy

36
Q

Liver Cell Failure

A

Jaundice

Leuconychia

Bruising

Ascites

Encephalopathy

37
Q

Signs of Portal hypertension

A

Splenomegaly

Ascites

Dilated veins on abdomen

Haematemesis and melaena

38
Q

With dilated abdo veins how to tell of portal hypertension or IVC obstruciton

A

Direction of the vein inferior to umbilicus

Portal Hypertension - blood flow away from umbilicus

IVC obstruction - towards the umbilicus

39
Q

Signs in Cholestasis

A

Excoriations

Pale stools

Dark urine - negative for urobilinogen

jaundice

Xanthelasma

40
Q

How to copare kidney and spleen in RIF

A

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

41
Q

Types of Erythema

A

Migratory Necrolytic Erythema

Chronicum Migrans

Marginatum

Ab igne

Multiforme

Nodosum

42
Q

Necrolytic migratory erythema associated with

A

Glucagonoma

43
Q

Chronic Migrans seen in

A

Lyme Disease

44
Q

Marginatum seen in

A

Acute Rheumatic fever

45
Q

Erythema Ab Igne seen in

A

Hotwater bottle

46
Q

Erythema multiforme

A

Target lesions SJS

47
Q

Nodosum seen in

A

variety

IBD

Sarcoid

Cnacer

dRUGS

Infections

48
Q

Action of Insulin

A

movement of Glut 4 to cell surface and movement of K+ and phosphate into cells

Stimulates fat generation

49
Q

In DKA what is treatment

A

Fluid

Insulin

Potassium

If pH is less than 7 have to give small amoun of bicarb as insulin doesnt work in that low pH

50
Q

Third nerve palsy with large pupil

A

COMPLETE third nerve palsy

51
Q

Surgical Third nerve palsy

A

Pupil is not spared

seen in Posterior communicating aneurysm

Pressure on nerve

52
Q

Why is it important to treat a squint in young

A

At birth the brain hasn’t developed the macula - if an image doesnt fall on the eye

get

AMBLIOPIA

from lack of developement

53
Q

Squint causes

A

Muscle weakness or strabismus (squint)

54
Q

Why do a cover test in a patient with a squint?

A

It proves that the 6th nerve (Abducting the eye) is working so no 6th nerve palsy present

55
Q

If patient states see double vision what should you do?

A

Work out which is the weak eye

Weak eye is responsible for the outer most image

56
Q

Causes of Unilateral Exopthalmos

A

Graves

Peri-orbital Cellulitis

trauma

57
Q

Causes of Complex othalmoplegia

A

Graves

Myathenic Gravis

Retro-orbital tumour

Miller-Fischer Syndrome

58
Q

Stages of diabetic retinopathy

A

Background

Pre-proliferative

Proliferative

Diabetic maculopathy

59
Q

Signs of Background retinopathy

A

hard exudates

Microaneurysm

Blot Haemorrhages

60
Q

Rx of background retinopathy

A

Improved control of DM - metformin

61
Q

What do cotton wool spots indicate?

A

retinal ischaemia

62
Q

Pre-proliferative stage

A

Cotton wool (ischamia)

Silver wiring and flame haemorrhages as thin walled vessels

63
Q

rx of cotton wool

A

Require laser tx to stop new vessel formation

Old - dark

new - bright

64
Q

Laser rx can be mistaken for what?

A

Retinitus Pigmentosa

which is spicular

Dominant condition which can also occur by itself

65
Q

What is Horners

A

Damage to the sympathetic chain

66
Q

Ix in Horners

A

X-ray for possible lung tumour

67
Q

Signs of hypertensive retinopathy

A
  1. Silver wiring
  2. AV nipping
  3. Cotton wool spots and flame haemorrhages
  4. Papilloedema
68
Q

What is homonomous hemianopia

A

Can’t see one side of vision even with both eyes open

69
Q

Who gets homonomous hemianopia?

A

Storke patients

70
Q

IVDU Cardio complications and Signs

A

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

71
Q

Malar Flush

A

Mitral Stenosis

72
Q

How can MS be heard better

A

After exercise

73
Q

Other conditions in MS

A

Af (50%)

74
Q

Chest x ray in Mitral stenosis

2 signs to look for

A

Left atrial enlargement

Pulmonary Haemosiderosis from pHTN

75
Q

Causes of AF

A

MS

Thyrotoxicosis

Caffeine/Alcohol

Ischameic Heart Disease

Rheumatic heart disease

Rheumatic Heart disease (common)

PE

Ca bronchus

76
Q

Rx AF

A

Rate and Rhythm

rate - BB or digoxin

Rhythm - Amioderone but bad SE

77
Q

What are the implications of using Digoxin in AF

A

It locks people into a lower rate

Suitable in people who don’t need their ventricular reserve (old)

78
Q

After MI if AV node stops working and they have a pulse rate of 30 what needs to happen?

A

Need PACING

79
Q

An LV aneurysm will show what on ECG?

A

ST elevation

80
Q

What are the signs of heart failure?

A

Lectures final revision (10 decks)

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