mmore bits Flashcards
notching of the inferior border of ribs sign of
coarctation of the aorta - this is due to dilatation of intercostal arteries, superior vena caval obstruction, arteriovenous fistula, or following a Blalock Taussig shunt.
The itnerocstals are dilated as it allows sufficient blood flow to reach the descending aorta. The pressure of these vessels erodes the inferior margin of the ribs.
Coarctation explains this patients refractory hypertension too.
what congential condition can cause refractory hypertension and why
coaractation - this cause increased afterload for the left ventricle resulting in an increased systolic pressure in the lV and upper part of the body
in what other condition can you see rib notching - but mainly in the upper proportion of the ribs.
marfans syndrome
iNR high - minor bleed tx
stop warfarin adn IV vit k
INH high and over 8 but a major bleed
stop warfarin , IV vit k and prothrombin complex
after atropine what can you give in bradycardiac event
external pacing via transcutaneous pacing then transvenous
first thing you do when someone reports someone unresponsive and not witnessed
1 shock 2 min cpr
first thing you do if you witness someone go into cardiac arrest
3 shocks intially given then cpr
angina pt already tried verampamil and asthmatic what is next on the list that can be given if still having exacerbations
isosobide mononitrate- long acting nitrate
what is the problem with combining ivabradine with a rate limiting CCB like verapamil
could lead to severe bradycardia
tx of type a aortic dissection - ascending aorta
Intravenous labetalol and immediately refer for aortic root replacement
tx of type b - descending
type B - descending aorta - control BP(IV labetalol)
aortic regurgitation sign of which aortic dissecton
type a - aortic dissection
side effect of ramipril
angioedema - marked toungue and facial swelling
what is secondary hypertension
high blood pressure caused by another medical condition
what is the most common cause of secondary hypertension
primary hyperaldonsteronism
This patient has hypokalaemia and hypernatraemia, which combined with hypertension suggests either
primary hyperaldosteronism, Cushing’s syndrome or renal artery stenosis.
To distinguish between these causes, you can perform a plasma renin: aldosterone ratio and a low-dose dexamethasone suppression test. It is important to note that although primary hyperaldosteronism often presents with hypokalaemia, this may not always be the case. It is most commonly caused by idiopathic bilateral adrenal hyperplasia, followed by an aldosterone-secreting adenoma of the adrenal gland (Conn’s syndrome).
Renal artery stenosis is incorrect. This is more likely to occur in older male smokers with atherosclerotic risk factors such as hypercholesterolaemia or, more rarely, younger women due to fibromuscular dysplasia. In renal artery stenosis, renal bruits may be heard on examination and there may be hypokalaemia and hypernatraemia due to hyperreninaemic hyperaldosteronism (high renin activating the renin-angiotensin-aldosterone system). Although this patient had hypertension with hypokalaemia and hypernatraemia, primary hyperaldosteronism is a much more common cause of this.
HF need annual what vaccination
influenza vaccination
