OSCE nuggets Flashcards
What is third HS heard in
HF
Young athletes
When is gallop rythm heard
HF on history of HTN
LVH vs HF on ECG and CXR
LVH- tall r waves and normal on X-ray cos heart grows in
HF- cardiomégalie and normal ECG
BMI levels
Overweight -25 30 Obese- 30 35 Severe obesity 35 40 Morbid obesity 40 50 Severe morbid 50+
How does obesity levels change with ethnicity
Over 23 is overweight in South Asians
What are you gonna do if BP over 140 diastolic
Check multiple times and and examine patient for signs of HTN
On examination what would be signs of HTN
Carotid bruits
S4
Fundoscopy
Heave
What is seen in grade 1 HTN fundoscopy
Silver wiring
What is silver wiring
Line in artery coming off the disc
What is grade 2 HTN fundoscopy finding
AV nipping
What is AV nipping
Crossing between artery and vein
What is grade 3 HTN of fundoscopy
Flame haemorrhages
Cotten wool spots showing ischaemia
What is grade 4 HTN fundoscopy finding
Papilloedema
What are secondary causes of HTN
Acromegaly Nephritis Renal artery stenosis Coarctation of aorta Cushing Cons Phaeos
What is primary HTN called
Essential HTN
Why do FBC HTN
Polycythaemia
Why do U&Es HTN
Low K is Conns or Cushing
See if kidney function affected in nephritis or renal artery stenosis
ECG finding HTN
LVH
What to look for urinalysis HTN
Nephritis
Investigations would do for HTN
FBC U&Es Glucose Lipids ECG Urinalysis
Most important investigation for secondary HTN investigations
U&Es
If suspected Renal artery causing HTN what is first line investigation for this
MR Angio as can see aortic coarctation too
What are 3 steps to diabetic retinopathy
Background
Pre-proliferative
Proliferative
What are signs of background retinopathy
Hard exudates
Microaneurysms
Blot haemorrhages
What are signs of pre proliferative diabetic retinopathy
Cotton wool spots
What are signs of proliferative retinopathy
New blood vessels formed due to ischaemia
What is maculopathy
When macula is damaged by retinopathy
What are signs of maculopathy
Hard exudates over macula
Antibiotics used in appendicitis
Cefoxamine and metronidazole
Who does appendicular mass occur in
People who wait to present
What are appendix perfs more common in
When faecolith involved- children
What in any abdo pain in young women is first line
Pregnancy
What does a positive psoas sign suggest about appendix position
Retrocaecal
What does a positive copes sign suggest about appendix position
Near to obturator externus
What non bowel symptoms are common in diverticulitis
Urinary ones
Especially when fistula- brown urine
What surgical procedure is done in diverticulitis
Hartmanns
What is a hartmanns procedure
Form colostomy bag leaving anorectal stump- once inflammation has died down will do promary anastomosis
Why cant you do primary anastomosis in diverticulitis
Oedema will mean when close the bowel there will be holes
What is first line investigation for diverticular disease
Barium swallow through
OPeration done in severe diverticular disease
Primary anastomosis
Complications of diverticular disease
Perf Diverticulitis Peri-colic abscess LBO Faecal peritonitis Fistulas
Risk factors to ask about in hernia history
Constipation
Chronic cough
Heavy lifting
Hernia presentation
Lump in groin
Groin pain
Scrotal swelling
Vomiting
Who does femoral hernias occur in
Elder females
Who does inguinal hernias occur in
Younger males
What do inguinal hernias contain
Bowel
What do femoral hernias contain
Omentum
In what position do hernias often reduce
Supinated
Signs of strangulated hernias
Tender Red Colicky pain Distension Vomiting
Difference in management of femoral and inguinal hernias
Will do surgery much more often in femoral as risk of strangulation
Which drugs cause pancreatitis
Thiazides
Azathioprine
Signs on examination of pancreatitis
Epigastric tenderness
Reduced bowel sounds
Fever
Shock
What does a normal Ca in glasgow score suggest about pancreatitis cause
Hypercalcaemia
What does very low Ca suggest about prognosis
Not good
How long after eating does chronic pancreatitis pain present
15-30mins
What is often new diagnosis in chronic pancreatitis
T2DM
1st line investigation for chronic pancreatitis
CT abdo- see calcified pancreas
Management of sigmoid volvulus
Rigid sigmoidoscope decompression
What is the other name for watershed zone
Griffiths
If ischaemia at griffiths point what is most likely cause of
Hypovolaemia ( water shed zone is griffiths point)
Which areas are susceptible to ischaemic colitis
Sudeks point
Griffiths point
Right colon
Where is sudeks point
Rectosigmoid junction
What are most likely causes of ischaemic colitis
Hypoperfusion
What are most likely causes of acute mesenteric ischaemia
VTE
Managment of ischaemic colitis vs mesenteric ischaemia
Mesenteric immediate surgery
Ischaemic conservative- fluids and bowel rest
What is presentation of mesenteric ischaemia
Vomiting
Diarrorhoea
Sudden onset diffuse pain
Risk factors mesenteric ischaemia
AF
Cocaine
Smoking
Triad for mesenteric ischaemia
Sudden diffuse pain
Normal exam
Shock signs
Investigations for acute mesenteric ischaemia
ECG
ABG
AXR
CT
Signs seen on imaging mesenteric ischaemia
Perforated
Megacolon
Dilated
Managment of occlusive mesenteric ischaemia no gangrene
Thrombectomy
Thrombolysis
Management of non-occlusive mesenteric ischaemia with no gangrene
Fluid resus
Presentation of ischaemic colitis
Post prandial gut pain history
PR bleeding
Weigjht loss
Causes of non occlusive ischaemia in bowels
SEPSIS
Shock
Trauma
Complication of iscahemic colitis
Ileus
Management of iscahemic colitis causing ileus
Drip and suck
Management of ischaemic colitis
IV fluids
Diet lifestyle management in diabetes
Low sugars and complex carbs
Snack less regularly
After metformin what are 3 drugs can choose from
Sulphonylureas
Gliptins
SGLT2i
How does metformin work
Reduces liver production of glucose and improves sensitisation to insulin
Pros of metformin
Shown to easily reduce Hb1ac
Improves reduced CVA events, life expectancy and cancer risk
Cons of metformin
Diarrorhoea
Metabolic acidosis risk
Symptoms for metformin acidosis
stomach pain, nausea, irregular heart rate, anxiety, hypotension (low blood pressure), rapid heart rate.
How do sulphonylureas work
Increase insulin production at level of pancreas
How can metformin does be delivered to help with diarrorhoea
Titre up slowly
What impact does sulphonylureas have on weight
Makes you gain weight
What is main risk of sulphonylureas
Can have hypoglycaemic episode
Who isnt sulphonylureas appropriate for
Overweight people
People who drive regularly or are truck drivers as risk of hypo
Cons of sulphonylureas
Weight gain
No benefit longer term in terms of mortality
Risk of hypos
What do gliptins do
GLP 1 enzyme inhibitor thus increases insulin production
Benefits of gliptins
Help reduce appetitie and lose weight
Good at lowering Hb1ac
Cons of gliptin
Risk of pancreatitis
Can have diarrorhoea
How do SGL2Ti work
Block a channel in kidney allowing glucose to pass out
Side effects of SGL2Ti
Polyuria and polydipsia
Genital infections
Positives of SGL2Ti
Especially helpful for kidney and heart failure patients- improved mortality
Help lose weight
Names of sulphonylureas
Glibenclamide
Glipizide
Names of gliptins
Vildagliptin
Saxagliptin
Names of SGLT2i
empagliflozin
If troponin and ECG neg what is next investigation
Exercise tolerance test
Gastro causes of chest pain
Oesophagitis
Gastritis
Oesophageal spasm
What is major risk factor for boerhaves perforation
Recent endoscopy
How high can JVP go
Up to ear can even appear pulsatile
Causes of tricuspid regurg
RV dilation
Leaflet damage- RF, endocarditis
What infection can commonly lead to pericarditis
TB
Rfs for pericarditis
TB
Recent URTI infection
CTD
What questions ascertains in syncope if LOC
Can you remember
What does sinus mean in reference to rythm
Present P waves
Causes of sinus tachycardia
Hypovolaemia Sepsis Pain Caffeine PE Endo- thyrotoxicosis, phaeochromocytoma
How to determine if AVRT or AVNRT
Return to normal rate and rythm
Amir sam causes of Afib
Thyrotoxicosis Alcohol Heart: - pericarditis - muscle. cardiomyopathy, IHD - Valvular Lung - PE - cancer - pneumonia
Causes of VT
Electrolyte abnormalities
Ischaemia
Long QT
Management of SVT haem stable
Valsalva and vagal manouevres
Adenosine
Treat cause
Management of SVT haem unstable
DC cardioversion
What can cause fixed splitting of S2
Atrial septal defect
If patient is hypothermic needing defib what must do
Warm up
Management of haem stable VT
IV amiodarone
Treat underlying cause
ICD
How to work out if LVH
Add deep S in V1 to tall R in V5/6 and if greater than 35 small squares
What scores are used to work out if anticoagulate in Afib
CHAD VASC
HASBLED
How to work out if long QT
Draw 2 lines between R waves and work out midpoint
If t wave here or further then long QT
Which type of stroke will normally lead to collapse
Haemorrhagic
Why do we feel carotid pulses
Hypovolaemia will be weak
Slow rising pulse for aortic stenosis
What does carotid feel like in aortic stenosis
Like a thrill
Slow rising
Weak
What is pulsus tardus and parvus seen in
Aortic stenosis
What is bifid carotid pulse seen in
Aortic regurg
What is the anion gap
Sodium and potassium - chloride and bicarbonate however chloride and bicarrbonate dont account for all of the negative ions so the anion gap is all those left that allow electroneutrality
What is a normal anion gap
Should be small
What is an abnormal anion gap
Very high- due to extra anions normally due to dissociated acid part
What causes a high anion gap
Lactate Uraemia Ketones Toxins KULT
What does hypoalbuminaemia indicate about liver disease
Chronic
What does isolated elevated PT suggest about liver disease
Acute liver disease
Causes of hyperkalaemia
Addisons Renal failure ACE Spironolactone Rhabdomyolysis Metabolic acidosis
Main ECG findings of hyperkalaemia
Bradycardia Absent or small p waves Long PR Broad QRS Tented T waves
Management of hyperkalaemia
ECG Calcium Gluconate 10% 10ml Salbutamol nebs.10mg Insulin 5-10 units \+ Glucose 50% 50mmol Regular VBGs
Symptoms of hypokalaemia
Weakness
Arrythmia
Hypokalaemia
Causes of hypokalaemia
Vomiting Diarrorhoea Loop diuretics Thiazide diuretics Conns Cushing
Arrythmia hypokalaemia can lead to
Torsades de pointes
What does RAAS do to k and na
Excretes K
Reabsorb Na
Keys to managment of hypo Na and K
Do it slowly
Na fast leads to central pontine myelinolysis
K is an irritant to veins so either cheset drain or slowly in cannula
Mild hyponatraemia presentation
Confusion
Severe hyponatraemia presentation
Vomiting
Seizures
Death
What causes ADH release
Low volume at carotid sinus
Low Na concentration
Why does ADH release cause hyponatraemia
It only retains water not Na like aldosterone as acts on collecting duct
Hypovolaemia signs on examination
Dry membranes Reduced skin turgor Postural hypotension HR up Reduced urine output Confused
What happens to urine sodium in hypovolaemia
Its low
Signs on examination of hypervolaemia
JVP up
Bibasal creps
Peripheral oedema
Why do you get hyponatraemia in hypovolaemia
Lose sodium and fluid however ADH only fixes water so volume goes up but sodium remains the same
Why do you get hyponatreamia in hypothyroidism
Reduced thyroxine reduces CO thus reducing apparent volume causing ADH release
How does addisons lead to hypovolaemic then euvolaemic hyponatraemia
Aldosterone production is reduced causing sodium loss and so also water loss leading to hypovolaemia. Then as reudced volume ADH increase water up to euvolaemic
Why dont you become hypervolaemic in SIADH
Initially you release too much ADH causing retention of water however this hypervolaemia triggers ANP and BNP release which gets rid of water and sodium
Causes of SIADH
CNS pathology such as meningitis, enchepahlitis and SAH
Surgery
Drugs- SSRIs, TCAs, opiates, PPIs, carbamezapines
Lung pathology
Investigation for euvolaemic hyponatraemia
Short SynACThen
TFTs
Urine osmolaltiy
Causes of hypernatraemia
Diabetes insipidus
Conns
Cushings
What is defined as HTN
BP over 140/90mmHg
If in OSCE take BP what do you offer to do
Take in both arms and if is difference of over 15 then recheck in the arm with highest BP
If you notice that BP is over 140/90 on first go what do you do
Ideally take 3 readings and take the lower of last 2
Once a clinic reading of 140/90 is made what is next step
Offer ambulatory BP measurement
What are 3 cut offs for ABPM
If under 135/85 then not hypertensive
If over 150/95 then stage 2 HTN
If over 135/85 then stage 1 HTN
What does stage 1 HTN mean for treatment plan
If under the age of 80 and has one of these then treat;
- established CVD
- renal disease
- diabetes
- organ damage
- 10 year risk of CVA over 10%
Way to remember HTN stage 1 reasons for treatment
CORD 10
What does it mean for stage 2 HTN
Treat all patients regardless of age
What is metformin contraindicated in
Renal failure due to lactica acidosis risk
What would be suspected in MI at young age
HOCM
Long QT
Familial hypercholesterolaemia
What can cause elevated lipids non lifestyle
Liver failure
Renal problems
Hypothyroidism
High glucose
Management plan for hypercholesterolaemia
Lifestyle
Statin
Ezetimibe
Bezafibrate
SEs of statins
Headache
Proximal myopathy
Flatulence
Tired
What is problem of nifedipine in malignant HTN management
Done too quickly- want to manage slowly down in around 24hrs
What is target BP for diabetics
130:80
What offer if BP less than 140:90
To check every 5 years maybe less if close to target
What must be measured when giving apixaban
Renal function
Investigations for stable angina
Bedside - ECG - Obs- BP to see if hypertensive Bloods - FBC - troponin - lipid profile - glucose or hba1c Imaging - ETT with ECG - ETT with echo - stress echo - cardac CT angiography - invasive coronary angiography
Management plan for stable angina
Lifestyle advice - lipid, diabetes and HTN management Aspirin 75mg or clopidogrel or both GTN spray for when in pain First line anti anginal of either CCB or beta blocker depending on SEs of patietns choice Then both if tolerated Second line ivabradine or long acting nitrate Third line PCI with stent or CABG
Why is FBC important in stable angina
Anaemia can exacerbate symptoms
In cardiac CT angio and invasive coronary angio what is defined as coronary obstruction
Stenosis of 50-70%
Management plan for acute UAP
Aspirin and clopidogrel
Nitrates- if not toleralted morphine
Fondaparinaux
Sent for ETT/stress echo then potential PCI
Investigations for UAP
Bedside - obs - ECG Bloods - troponin - FBC - U&Es - LFTSs - lipids - glucose/Hba1c Investigations - stress echo - echo - ETT - myoview of heart - cardiac CT angio - invasive angio with potential PCI
Why are LFTs important in ACS
Check clotting for anticoagulation
Why are U&Es important ACS
Baseline
Why do an Echo UAP
See if any regional wall abnormaliites
Check LVF
What is seen in myocardial perfusion scan of heart UAP
Unmatched perfusion between rest and stress
Long term management of UAP
Continue on aspirin for life and clopidogrel for one year
Statin
Beta blockers or verapmil or carvedilol (mainly beta blocker)
ACEi/ARB
Spironolactone
DM/HTN management
What is verapamil MOA
CCB
What class of drug is clopidogrel
P2Y12 inhibitor
What are 2 P2Y12 inhibitors
Clopidogrel
Ticagrelor
What is MOA of flecainide
Sodium channel blocker
What are 2 examples of ARBs
Losartan
Candesartan
MOA of thiazides
Inhibits Na/Cl channel DCT
2 examples of thiazide diuretics
Bendroflumethazide
Indapamide
MOA of spironolactone
Aldosterone inhibitor
What does ARB stand for
Angiotensin 2 receptor blocker
MOA of digoxin
Reduces HR and also improves contractility
Management plan of Type B aortic dissection
If no end organ ischaemia
- beta blockade using labetalol
- aiming for HR under 60 and systolic under 120 so if beta blockade fails use vasodilator therapy
- first line vasodilator therapy is nitropusside
- second line diltiazem
If end organ failure open surgery or endovascular graft
BP managemet in any aortic dissection
Beta blockade using labetalol
Aim for HR under 60 and sys under 120
If beta blockade fails use 1st line nitropusside, 2nd line diltiazem
Investigations ordered for aortic dissection
Bedside - BP in both arms - ECG Bloods - FBC - U&Es - LFTs - G&S - troponin - VBG Imaging - CXR - CT angio - echo
What can be seen aortic dissection on ECG
St depression or ST elevation
CXR findings aortic dissection
Widened mediastinum with blunted aortic knuckle
Can get pleural effusion
Risk factors for pericarditis
TB CTD Recent MI URTI- viral Cancer Uraemia
Where can pericarditis pain also be
Trapezius ridge
O/E constrictive pericarditis
Pericardial friction rub
Raised JVP
HF signs possible
Management plan for pericarditis
NSAIDS(aspirin or ibuprofen) with PPI!
Colchicine
Exercise restriction
Second line steroids if unresponsive
Investigations for pericarditis and findings
ECG- widespread concave ST elevation Throat swab Bloods - FBC- lymphocytosis - U&Es- uraemia is cause - troponin Echo- pericardial effusion or helps distinguish from MI and pericardial thickening helps distinguish from restrictive cardiomyopathy Pericardiocentesis helps identify cause
Examples of target organ failure in HTN
LVH
Retinopathy
Increased albumin to creatinine ratio
CKD
In stage 2 HTN when is a statin given
If q risk over 10%
What is as significant contraindications for CCB
HF
What is main side effect of thiazides
Sexual dysfunction
Complications of pneumothorax
Bronchopleural fistula
Recurrent pneumothoraces are common- 20% chance of repeat
Management of recurrent pneumothoraces
PLeuroidesis using sclerosants like tetracycline
Diffuse abdo pain with nausea and vomiting
Obstruction
Mesenteric ischaemia
How does acute mesenteric ischaemia present
Acute diffuse abdo pain
Nausea and vomiting
Haematochezia
Complains of post prandial pain
What is small meal syndrome
When due to chronic mesenteric ischaemia you start eating smaller meals due to pain caused by eating larger ones
Risk factors for liver abscess
intrahepatic processes/surgery DM Biliary disease GI infection Recent travel
Difference in pain of SBO vs LBO
SBO pain higher up due to somatic supply
LBO lower and spasms last for longer
What is PT in obstructive causes of jaundice
High as reduced absorption of VIT K
US finding of cholangiocarcinoma
Mass
Dilated bile ducts
What are 2 cancer markers raised in cholangiocarcinoma
CA19-9
CEA
Ratio of CA19-9>40xCEA
What non cancerous disease is CEA raised in
IBD
Why isnt measuring CEA to screen adenocarcinoma in UC a good idea
Also elevated in UC
Why do U&Es plus LTFs in sarcoidosis
Can get liver and renal involvement
Management of diverticular disease
Improved diet and hydration
If bacterial overgrowth suggested give abx
If symptoms persist for a while can consider surgery
Management plan for diverticulitis
Analgesia
Fluids
Abx
Consider surgery if perforation, abscess, fistula or excessive bleeding
What should be done if excessive bleeding that cant be stopped in acute diverticulitis
Consider transfusions
CT angio or isotope labelled red blood cell nuclear scan
Complications of diverticulitis
Abscess Fistula Perforation Sepsis Excessive bleeding
Investigatons for acute diverticulitis
Bloods FBC- neutrophillia, CRP up, anaemia U&Es for baseline Blood cultures G&S CT eCXR or AXR to look for pneumoperitoneum
What is seen on CT diverticulitis
Abscess
Fistula
Thickened bowel walls
Outpouchings inflammed
What can be done for patients who have regular COPD exacerbations
Arithomycin thrice weekly
Who does constipation cause confusion in
The elderly especially post op
What causes ischaemic colitis in younger people
Cocaine use
What happens to Hba1c in hereditary spherocytosis
It decreases and is so underestimated
What causes PSM heard loudest at left sternal edge lower down and with louder P2
VSD
If variceal haemorrhage is uncontrolled with terlipressin what must be done prior to endoscopy
Insertion of sengstaken blakemore tube
If patient has atelectasis what is best immediate management
Sit patient up
Then refer for chet physio
What can cause ischaemic hepatitis
Sepsis leading to hypoperfusion
Clot
What artery most commonly affects the trigeminal nerve in TN
Superior cerebellar artery
What can be secondary causes of cluster headaches
Pituitary adenoma or hypothalamic dysregulation
Pathophysiology of cluster headaches
hypothalamic activation with secondary trigeminal and autonomic activation
What can trigger a cluster headache
Alcohol
Stress
Sleep
Volatile smells
Investigations for cluster headache
ESR to rule out GCA
MRI to rule out secondary pituitary or hypothalamic cause
Pituitary function tests can rule out secondary cause
What is seen on head CT of extradural
Lemon shaped bleed
Midline shift and cerebral oedema
What is alternative cause of extradural and how would be investigated
AV malformation
CT angio
Major criteria for rheumatic fever
JONES pnemonic Arthritis Carditis Nodules sub cut Erytherma marginatum Sydenhams chorea
Minor criteria for rheumatic fever
Raised CRP
Raised ESR
Fever over 38.5
Prolonged PR
Investigations for rheumatic fever
Bloods -ESR -CRP -WCC ECG - can show elongated PR Echo - valve damage PCR or throat culture for strep Anti-streptolysin titres
How does erythema marginatum appear
Ring like appearance on torso and legs
What is management of gallstones
If symptomatic give NSAIDS like diclofenac and offered laparoscopic cholecystectomy
If asymptomatic from being found incidentally dont offer cholecystectomy unless signs of porcelain gall bladder, high risk of GB cancer and chronic risk like SCD
When would you offer cholecystectomy in asymptomatic biliary colic
Signs of porcelain GB
High risk of GB cancer
Chronic risk from diseases like SCD
What are main complications of biliary colic
Cholecystitis Cholangitis Pancreatitis Mirrizi syndrome Gallstone ileus
Investigations ordered for bilairy colic
Bloods - FBC looking for WCC - CRP as inflammation - LFTs see if liver function deranged - amylase - lipid profile Imaging - US showing gallstones, dilated ducts and sludge - MRCP and CT also showing this Only really would do this if stones unidentifiable or signs of complications
What is most common viral cause of subacute thyroiditis
Cocksackie virus
Investigations for subacute thyroiditis
Bloods
- ESR and CRP up
- TFTs depends on the stage of disease
- antithyroid peroxidase abs can be present
Imaging
- scintigraphy will show global reduced uptake
- FNA will show granulomas and WCC infiltration
How long cant you drive for following a first unprovoked seizure
6 months
O/E idiopathic pulmonary fibrosis
Clubbing
Fine late inspiratory crackles
What should be ruled out in initial idiopathic pulmonary fibrosis screen
RA
Myositis
What is positive BPPV finding
Delayed onset torsional unilateral nystagmus
What is podagra
Gout
What are smudge/smear cells
Remnants of cells
RFs for saccular aneurysms
Marfans
Ehlers
PCKD
NF1
What is lupus vernio seen in
Sarcoid
What are risk factors for burkitts lymphoma
Immunosuppression- HIV
EBV
Investigations for SIADH
TFTs
Short Synacten to rule out these as causes of euvolaemic hyponatraemia
What is difference in pupil between anterior uveitis and closed angle glaucoma
Dilated in glaucoma
Constricted in anterior uveitis
what is finding of CSF in GBS
High protein
Albumin cytological dissociation
What indicates severity of mitral stenosis
Length of murmur
How to diagnose zollinger ellison syndrome
Fasting gastrin level
How is nephrogenic diabetes insipidus treated
Thiazide diuretics
How is cranial diabetes insipidus treated
Intranasal desmopressin
What virus predisposes to MS
EBV
What 2 lifestyle changes will help improve BP
Lose weight
Eat less salt
What cardiac abnormailities are seen in carcinoid syndrome
Pulmonary stenosis
Tricuspid insufficiency
O/E myocarditis
HF signs
Sinus tachycardia
Arrythmias common
Investigations for myoarditis
Bloods - WCC up - CK MB up - troponin very up ECG - non specific ST elevation and depression - some T wave inversion CXR - bibasal crackles if in HF Echo - global dyskinesia - LV dilation Endomyocardial biopsy - infiltration and necrosis
Management plan for bronchiectasis
All patients - improve diet and exercise - physio Some patients - inhaled bronchodilator - mucolytic (hypertonic saline)
What is example of mucolytic used in bronchiectasis
Hypertonic saline
What is done for patients with bronchiectasis who have over 3 exacerbations a year
Inhaled abx
When are patients with bronchiectasis given inhaled abx
If have over 3 exacerbations a year
What causes systolic HF
Arrythmia
Cardiomyopathy
MI
What causes diastolic HF
Constrictive pericarditis
Valve regurg
HTN
Why in stroke do you stop anticoagulants
Is risk of haemorrhagic transformation
Immediate treatment for stroke
Aspirin 300mg and stop anticoags
Anticoagulation for stroke first 2 weeks
Aspirin 300mg and stop anticoags
Anticoagulation for stroke after first 2 weeks
Stop aspirin
Clopidogrel 75mg OD
Specialist consideration for anticoags depending on cause etc
What is given to someone just before going to PCI regardless of if NSTEMI or STEMI
Unfractionated heparin
Immediate antplatelet therapy in ACS
Aspirin 300mg
Clopidogrel 300mg or ticagrelor 180mg
