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Medicine > Peer Teaching > Flashcards

Peer Teaching Flashcards

1
Q

How can CXR interpretation be structured?

A
  • Details
  • RIPE-> rotation, inspiration, picture, exposure
  • Soft tissues + bones
  • Airways + mediastinum
  • Breathing
  • Circulation
  • Diaphragm
  • Extras-> PICC lines, NG tubes etc
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2
Q

Why might someone be given clarithromycin as well as IV co-amoxiclav in severe CAP?

A

To cover for atypical pathogens

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3
Q

What are patients allergic to penicillin given in pneumonia?

A

Doxycycline

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4
Q

What are some features of moderate asthma?

A

-PEFR 50-75% of predicted

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5
Q

What are some features of acute severe asthma?

A
  • PEFR 33-50% of predicted
  • Pulse 110+
  • Inability to complete sentences in 1 breath
  • Oxygen sats >92%
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6
Q

What are some features of life threatening asthma?

A
  • PEFR <33%
  • Sats <92%
  • Reduced consciousness
  • Arrythmias
  • Poor resp effort
  • Silent chest
  • Confusion
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7
Q

How is acute asthma managed?

A
  • Oxygen-> aim for 94-98%
  • Neb’d salbutamol
  • Neb’d ipratropium bromide
  • Prednisolone (PO) or hydrocortisone (IV)
  • IV magnesium
  • Antibiotics
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8
Q

What should be monitored when treating acute asthma?

A

U+Es-> salbutamol can cause hypokalaemia

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9
Q

What can trigger an asthma attach?

A
  • Infection
  • Smoking
  • Poor asthma control
  • Poor inhaler technique
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10
Q

How is primary spontaneous PTX managed?

A

Needle aspiration (if >2cm)

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11
Q

How is secondary spontaneous PTX managed?

A

Chest drain

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12
Q

How does tension PTX present?

A

Hypotension, hypoxia reduced breath sounds, tracheal deviation

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13
Q

How is tension PTX managed>

A
  • Large bore cannula into pleural space
  • Then chest drain
  • 2nd anterior intercostal space mid-clavicular line
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14
Q

What can cause transudate pleural effusion?

A
  • CCF
  • Liver cirrhosis
  • Liver failure
  • Nephrotic syndrome
  • Renal failure
  • Due to oncotic/hydrostatic pressures
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15
Q

What can cause exudate pleural effusion?

A
  • Local factors cause changed in pleural fluid movement
  • Infection
  • Local malignancy
  • Local trauma
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16
Q

Which type of pleural effusion contains lots of protein (>30g/L)

A

Exudative

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17
Q

What is the pathophysiology of transudative pleural effusion?

A
  • Increased hydrostatic pressure due to venous outflow obstruction
  • Decreased colloid osmotic pressure due to decreased protein synthesis
  • Fluid leaks out of vessels
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18
Q

What is the pathophysiology of exudative pleural effusion?

A
  • Vasodilation and stasis
  • Increased interendothelial space
  • Both due to inflammation
  • Fluid and proteins leak out of vessels
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19
Q

What can be used to diagnose exudative pleural effusion?

A

Lights criteria

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20
Q

What can be used to quantify the severity of breathlessness?

A

MRC dyspnoea scale

  • 1-> not troubled except on strenuous exercise
  • 2-> SOB when hurrying or walking up slight hill
  • 3-> walk slow on level ground or has to stop for breath when walking at own pace
  • 4-> stop for breath after walking 100m or few mins on level
  • 5-> too breathless to leave house or SOB when dressing
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21
Q

How can COPD be diagnosed?

A
  • Spirometry
  • CXR-> hyperinflation
  • High resolution CT scan-> emphysema/chronic airway disease signs
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22
Q

What extra bits should be done/given in COPD?

A
  • Smoking cessation support
  • Pneumococcal and flu vaccines
  • Pulmonary rehab if indicated
  • Personalised self-management plan
  • Co-morbidity management
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23
Q

How should someone with COPD (without asthmatic/steroid responsive features) be managed?

A
  • SABA or SAMA PRN
  • Then LABA + LAMA
  • Then LABA + LAMA + ICS 3 months trial
  • Then revert back to LABA + LAMA if no improvement
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24
Q

How should someone with COPD (with asthmatic/steroid responsive features) be managed?

A
  • SABA or SAMA PRN
  • Then LABA + ICS
  • Then LABA + LAMA + ICS
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25
Q

How is acute exacerbation of COPD managed?

A
  • Nebulisers or inhalers
  • 30mg oral prednisolone 5 days
  • Antibiotics-> amoxicillin 5 days (but depends on sputum culture)
  • Theophylline
  • O2/NIVs-> target 88-92%
  • ‘Rescue pack’-> pred + amoxicillin
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26
Q

When is CPAP used?

A

Type 1 resp failure-> hypoxia

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27
Q

When is BiPAP used?

A

Type 2 resp failure

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28
Q

What can cause acute heart failure?

A

CHAMPS

  • ACS
  • Hypertensive crisis
  • Arrhythmia
  • Mechanical/metabolic
  • PE
  • Sepsis
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29
Q

How can acute heart failure be managed?

A
  • IV furosemide
  • High flow oxygen
  • Digoxin or beta blocker if AF
  • If not improving-> IV GTN, CPAP, dobutamine
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30
Q

What are some potential CXR findings in acute heart failure?

A
  • Alveolar oedema-> bats wings
  • Kerley B lines
  • Cardiomegaly
  • Dilated upper lobe veins
  • Effusions
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31
Q

What can cause raised BNP?

A
  • Heart failure
  • ACS
  • PE
  • Myocarditis
  • CKD
  • Liver cirrhosis
  • Sepsis
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32
Q

How does BNP correlate to symptoms + prognosis in HF?

A

Higher levels-> worse mortality but not necessarily symptoms

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33
Q

What symptoms might be described in heart failure?

A
  • SOB
  • Fatigue
  • Orthopnoea
  • Paroxysmal nocturnal dyspnoea
  • Wheeze
  • Leg swelling
  • Abdominal swelling
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34
Q

What signs may be elicited in heart failure?

A
  • Raised JVP
  • Creps in lungs
  • 3rd heart sound
  • Pedal oedema
  • +ve hepatojugular reflex
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35
Q

How does furosemide work in heart failure?

A
  • Loop diuretic
  • Inhibits Na/K/Cl transporter in loop of Henle
  • Stops electrolyte reabsorption-> diuretic
  • Dilated veins to reduce preload
36
Q

What medicines can improve prognosis in heart failure?

A
  • ACE-i
  • Beta blocker
  • Spironolactone
  • Sacubitril-Valsartan
  • SGLT2-inhibitor
  • Ivabradine
  • Isosorbide mononitrate
  • Hydralazine
37
Q

Is troponin needed to diagnose STEMI when seen on ECG?

A

No

38
Q

If STEMI is present in leads II, III and aVF, which artery is affected?

A

RCA

39
Q

What meds are given in immediate management of STEMI?

A
  • Aspirin
  • 2nd antiplatelet-> ticagrelor, clopidogrel, prasugrel
  • Sublingual GTN
  • IV morphine
  • IV metaclopramide
40
Q

A patient develops bradycardia + irregularly irregular pulse after being treated for inferior STEMI. What is this?

A

Heart block-> secondary to inferior MI

41
Q

What meds should be prescribed to patients post-MI?

A
  • Atorvastatin
  • Ramipril
  • Bisoprolol
42
Q

What lifestyle advice should be given to patients post-MI?

A
  • Cardiac rehab
  • Stop smoking
  • Healthy diet
  • Lower alcohol intake
43
Q

What can cause irregular narrow complex tachycardia?

A
  • AF
  • Atrial flutter with variable block
  • Frequent atrial ectopics
  • Multifocal atrial tachycardia
44
Q

What investigations would be suitable to perform in AF?

A
  • ECG
  • Observations
  • TFTs
  • FBC
  • U+E
  • Mg
  • LFT
  • Clotting screen
  • Echo
45
Q

What anticoagulant should be used in AF if a patient has mitral stenosis?

A

Warfarin

46
Q

What anticoagulant should be used in AF if a patient has a metal heart valve?

A

Warfarin

47
Q

How does warfarin work?

A
  • Vitamin K antagonist
  • Inhibits vitK epoxide reductase-> needed to activate vitamin K
  • Stops vitK dependent clotting factor synthesis-> 2, 7, 9, 10
48
Q

What drugs can be used to control heart rate in AF?

A
  • Bisoprolol
  • Verapamil
  • Diltiazem
  • Digoxin
49
Q

How should patients who are haemodynamically unstable with AF be managed?

A

Electrical cardioversion

50
Q

What organisms can cause infective endocarditis?

A
  • Staph aureus
  • Strep viridans
  • Coagulase negative staph
  • Enterococcus
  • HACEK
51
Q

Which valve is most affected in endocarditis?

A

Tricuspid-> injecting (IVDU) + bacteria hits this valve first

52
Q

What signs of immune complex depositions can be present in endocarditis?

A
  • Haematuria
  • Osler nodes-> painful
  • Splinter haemorrhages
  • Roth spots
53
Q

What affect can septic emboli have in endocarditis?

A
  • Abscesses
  • From left heart to brain, kidneys, spleen, gut, bone, skin (Janeway lesions)
  • From right heart to lung
54
Q

Why are serial ECGs done in aortic valve endocarditis?

A

PR prolongation can indicate aortic root abscess (press on AVN)

55
Q

Why are antibiotics given empirically in endocarditis?

A
  • Bactericidal-> immune system not good at getting to heart valves (poor blood supply)
  • Gentamicin-> can’t usually get into streptococci
  • Benpen-> breaks down strep walls + allows gentamicin in to kill bacteria
  • Both-> gram +ve and gram -ve cover
56
Q

What antibiotics are used in endocarditis and how long for?

A

Amoxicillin + Gentamicin for 4-6 weeks

57
Q

When is surgery indicated in endocarditis?

A
  • Abscess formation
  • Acute heart failure
  • Prosthetic valve dehiscence
  • Recurrent emboli
  • Infection spreads past valve
58
Q

What is the definition of a stroke?

A

Acute neurological deficit of vascular origin lasting 24+ hours or causing death

59
Q

What can cause stroke?

A

ASCOD grading

  • Atherosclerosis
  • Small vessel disease-> lipohyalinosis (due to age/HTN) causing lacunar infarcts or microhaemorrhages
  • Cardiac pathology-> AF, MI, valvular, endocarditis
  • Other-> SLE, anti-phospholipid syndrome, sickle cell, moyamoya disease, vasculitis
  • Dissections
60
Q

What causes cerebral small vessel disease?

A
  • HTN or atherosclerosis
  • BVs can’t dilate in response to reduced flow
  • Blocked by atherosclerotic plaque
  • Bleeds
61
Q

What is a lacunar infarct?

A
  • Small vessel stroke

- Can cause basal ganglia + internal capsule damage

62
Q

What is an incomplete infarct?

A

-Arterial occlusion with resultant ischaemia of moderate severity

63
Q

What is a watershed infarct?

A
  • Watershed zone-> regions between vascular territories

- Vulnerable when sudden reduction in arterial BP-> CR arrest, anaphylaxis, major blood loss etc

64
Q

What is a total anterior circulation stroke?

A

Stroke in anterior cerebral + middle cerebral arteries

65
Q

What are the symptoms/criteria of total anterior circulation stroke?

A

All 3…

  • Unilateral weakness (+/- sensory deficit) of face, arm + leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction-> dysphagia, visuospatial disorder
66
Q

What are the symptoms/criteria of partial anterior circulation stroke?

A

Need 2/3…

  • Unilateral weakness (+/- sensory deficit) of face, arm + leg
  • Homonymous hemianopia
  • Higher cerebral dysfunction-> dysphagia, visuospatial disorder
67
Q

What are the symptoms/criteria of posterior circulation stroke?

A

Need 1…

  • CN palsy + contralateral motor/sensory deficit
  • Bilateral motor/sensory deficit
  • Cerebellar dysfunction (DANISH)
  • Conjugate eye movement problems
  • Isolated homomymous hemianopia
68
Q

What are the symptoms/criteria of lacunar stroke?

A
  • Pure motor
  • Pure sensory
  • Pure motor + sensory
  • Ataxic hemiparesis
69
Q

What is the ROSIER criteria?

A

Rule Out Stroke In ER

  • LOC/syncope? (-1)
  • Seizure? (-1)
  • New acute asymmetrical facial weakness (+1)
  • New acute asymmetrical arm weakness (+)
  • New acute asymmetrical leg weakness (+1)
  • New acute speech disturbance (+1)
  • New acute visual field defect (+1)
70
Q

What is Broca’s dysphasia?

A
  • Expressive/non-fluent

- Understand what’s being said but can’t express self

71
Q

What is Wernicke’s dysphasia?

A
  • Receptive/fluent
  • Fluent speech but doesn’t make sense
  • Can’t understand what’s being said
72
Q

How is stroke investigated?

A
  • Non-contrast CT-> rule out haemorrhage
  • ECG
  • Bloods-> FBC, U+E, LFT, lipids, TFT, cholesterol, glucose, clotting, INR (if warfarin)
  • May use-> CT angiography, perfusion weighted MRI, carotid doppler, echo
73
Q

What can be seen on perfusion/diffusion weighted MRI in stroke?

A
  • Ischaemic core

- Penumbra-> area surrounding core that could infarct

74
Q

What causes brain cell death in stroke?

A
  • Perfusion + energy failure
  • Na/K+ ATPase pump failure-> Na+ stays in cell
  • Release glutamate-> excitotoxic
  • Ca2+ influc-> cell death
  • Water influx (follows Na+)-> oedema + raised ICP-> coning-> death
75
Q

How is stroke managed?

A
  • Aspirin 300mg
  • Thrombolysis-> within 4.5 hours symptom onset + CT head (rule out haemorrhage)
  • Mechanical thrombectomy-> within 24 hours symptoms +/- thrombolysis if eligible
  • NBM + NG tube
  • Aspirin 300mg for 2 weeks then 75mg
  • Clopidogrel 75mg OD if aspirin CI’d
  • Statins
76
Q

What would indicate neurosurgery referral in stroke?

A
  • Dropping GCS
  • Severe headaches
  • N+V
  • Sudden BP increase
  • Large MCA or cerebellar infarct-> within 48 hours
77
Q

What is transient ischaemic attack?

A
  • Brief period of cerebral ischaemia

- Usually lasts <24 hours

78
Q

What is amaurosis fugax?

A
  • Temporary vision loss in one eye

- Can be due to TIA of retinal blood supply

79
Q

How long after TIA should a patient stop driving for?

A

1 month

80
Q

How long after stroke should a patient stop driving for?

A

At least 1 month

81
Q

What can cause intracranial mass?

A
  • Brain-> tumour, oedema, abscess
  • Blood-> SAH, ICH, extra-dural
  • CSF-> increased production, obstruction, reduced absorption
82
Q

How can raised ICP be managed?

A
  • Mannitol-> osmotic diuretic
  • Hyperventilation-> to increase pO2 + decrease CO2
  • Hypertension-> improve mean arterial pressure
  • Head up-> improve venous drainage
  • Intubation
  • Thiopental
  • Surgery-> Burr hole, craniectomy etc
  • Monitoring-> transcranial doppler etc
83
Q

What are some signs of raised ICP?

A
  • Fixed dilated (blown) pupil-> CNIII compression due to temporal uncal herniation
  • Cushing’s triad-> decreased RR + bradycardia + HTN due to CR centre compression through foramen magnum
84
Q

What is Cushing’s triad and what does it indicate?

A
  • decreased RR + bradycardia + HTN

- due to CR centre (in medulla oblongata) compression through foramen magnum

85
Q

What are the different components of GCS?

A
  • Eye opening (4)-> spontaneous, to speech, to pain, no response
  • Verbal response (5)-> oriented, confused, inappropriate words, incomprehensible sounds, no response
  • Motor response (6)-> obeys commands, moves to localised pain, flex to withdraw from pain, abnormal flexion, abnormal extension, no response

Medicine (13 decks)

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