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Medicine block (Y3) > Pink summary book 2/3 > Flashcards

Pink summary book 2/3 Flashcards

1
Q

general tips for X-rays

A
  • dont be too specific
  • opacification not consolidation
    • zones not lobes
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2
Q

CXR presentation

A

ABCDE

  1. Confirm pt details
  2. Quality of image (rotation, inspiration, projection, exposure)
  3. Airway (central trachea, carina and bronchi)
  4. Breathing/bones (lung zones, opacification, absence of lung markings, pleura, meniscus sign, fracture/lytic lesions)
  5. Cardiac/circulation (Hilar structures, heart size, heart borders)
  6. Diaphragm (L= gas from stomach, R= higher up due to liver, flattened, costophrenic angles)
  7. Everything else (aortic knuckles, aortic pulmonary window, soft tissue, tubes, valves and pacemaker)
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3
Q

what can cause a deviated trachea

A

Pathology

  • pulled→ atelectasis
  • pushed → pneumo and pleural effusion

Rotation of pt

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4
Q

opacification sign of

A

infection/ cancer / fluid

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5
Q

calcification of hilar vessels due to

A

calcification

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6
Q

bilateral enlargement of hilar structures

A

sarcoidosis

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7
Q

causes of blunted costophrenic angles

A

fluid

consolidation

COPD

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8
Q

causes of blunted costophrenic angles

A

fluid

consolidation

COPD

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9
Q

review areas on x-ray

A
  • lung apices (TB and batwing sign)
  • retrocardiac region
  • behind diaphragm
  • peripheral region of lungs
  • hilar regions
    • situs invertus
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10
Q

ECG presentation

A
  1. Confirm patients details
  2. regular or irregular
  3. heart rate
  4. heart rhythm
  5. sinus? P waves before each QRS
  6. cardiac axis
    7.
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11
Q

regular or irregular

A

use paper to see spacing

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12
Q

heart rate

A
  • tachy or brady?
  • regular- 300/ no. of boxes R-R
    • irregular- no. of QRS in rhythm strip x6
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13
Q

heart rhythm

A

regular

regularly irregular

irregularly irregular

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14
Q

heart rhythm

A

regular

regularly irregular

irregularly irregular

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15
Q

Sinus

A
  • regular rhythm
    • always p waves inf ront of QRS
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16
Q

P waves

A
  • sawtooth- flutter
  • chaotic- fib
  • flat- no atrial activity
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17
Q

which leads to look at for cardiac axis

A
  • Look at limb leads only (II, AVL, III)
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18
Q

Normal axis

A
  • lead II most positive
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19
Q

Left axis deviation

A
  • AVL most positive
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20
Q

Right axis deivation

A

lead III most positive

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21
Q

PR intevral

A

120-220ms

  • prolonged if >0.2s
    • AV delay e.g. heartblock
  • shortened
    • accessory pathway
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22
Q

QRS

A

narrow <0.12

wide >0.12

tall= ventricular hypertrophy

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23
Q

QRS morphology

A
  • delta waves
  • Q waves
  • R waves
  • S waves
  • J point segment
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24
Q

delta waves

A

slurred upstroke e.g. wolf-P-W

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25
Q

Q waves

A

previous MI

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26
Q

ST segment

A

should be isoelectric

  • ST elevation- full thickness ischaemia
  • ST depression- ischaemia
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27
Q

T waves

A
  • tall= ‘tented’
    • hyperkalaemia
  • hyperacute
    • STEMI
  • inverted
    • ischaemia
    • BBB
    • PE
  • biphasic
    • ischamia
    • hypokalamia
  • flattened
    • ischaemia
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28
Q

U wave

A

electrolyte imbalance

It comes after the T wave of ventricular repolarization and may not always be observed as a result of its small size. ‘U’ waves are thought to represent repolarization of the Purkinje fibers.

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29
Q

causes of atrial fibrillation

A
  1. ismchaemic heart disease
  2. mitral valve disease
  3. thyrotoxicosis
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30
Q

causes of atrial fibrillation

A
  1. ismchaemic heart disease
  2. mitral valve disease
  3. thyrotoxicosis
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31
Q

thyrotoxicosis

A

exopthalmos

low BP

increased sympathetic drive i.e. AF

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32
Q

treatment of AF when patient is haemodynamically stable

A
  1. Anticoagulation to prevent stroke - DOAC
  2. Rate control - B- blocker or digoxin

If patient is not haemodynamically stable

  1. Rhythm control- Cardioversion
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33
Q

DOACs

A
  • Inhibits factor Xa (apixaban, rivaroxaban and edoxaban) or direct thrombin inhibition (dabigatran)
  • Don’t need regular testing of levels compared to the INR monitoring of warfarin
  • No restrictions on food or alcohol
  • Excreted by the kidney so renal function is monitored yearly
  • Lower rate fo bleeding to warfarin and slightly better reduction in strokes
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34
Q

Triggers of AF

*

A
  • Binge drinking
  • Obesity
  • Cocaine ad amphetamines
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35
Q

People with AF are at risk of

A
  • Cardioembolic stroke- due to stasis of blood in the atria
  • Cardiac instability
  • And higher risk of death
  • Increased healthcare cost
36
Q

Diagnosis of AF

A
  • Pulse- irregularly irregular
  • Symptoms
    • Breathlessness
    • Palpitations
    • Syncope/dizziness
    • Chest discomfort
    • Stroke or TIA
  • ECG
  • Echcardiogram
37
Q

pulmonary embolisms investigations

A

only do a D-dimer in someone at low risk fo PE -→ otherwise straight to a CTPA (gold standard)

-→ if haemodynamically stable give oral anticoagulant

38
Q

with PE always think

A

could be cancer

39
Q

massive PE will result in

A

reduced BP → thrombolyse

40
Q

when to anticoagulate

A

risk benefit

compare risk of bleeding (HAS-BLED) with risk of clot (CHA2DS2VaSc)

41
Q

vocal resonance can be measured on

A

auscultation or on palpation

42
Q

increased vocal resonance

A

due to increased consolidation (Solid) -→ pneumonia

43
Q

decreased vocal resonance

A

due to increased fluid = liquid e.g. pleural effusion

44
Q

air bronchogram

A

air filled bronchi made clear by opacification of surrounding alveoli i.e. in pneumonia

45
Q

AKI blood test results and treatment

A

increased creatinine and urea

give fluids

46
Q

why ask about birds/ parots

A

atypical pneumonia e.g. chlamydia psittacosis

47
Q

batwing distribution on X-ray

A

pulmonary oedema

  • apical and basal sparing due to fluid leaving from the hilum (middle zones)
    • give furosemide
48
Q

MI basic treatment

A

MONA

  • morphine
  • oxygen (only if below 94%)
  • nitrate (GTN)
  • aspirin (STAT- 300mg)

then PCI-→ consider clopidogrel in prpe

49
Q

prinzmental angina

A

vasospastic angina that occurs at rest

50
Q

causes of COPD exacerbation

A
  • recent decrease in diuretics
    • infection
51
Q

define heart failure

A

inability of the the heart to meet the demands of the bod

52
Q

heart failure basic treatment

A

BAD

Beta blockers

ACEi

Diuretics

53
Q

what makes sure the heart pumps effectively

A
  • one way valve -→ blood goes in one direction
  • chamber size-→ if too small reduced preload
    • functioning muscle
54
Q

causes of HF

A
  • Ischaemic heart disease-→ remodelling due to fibrosis after ischaemia
  • HTN→ increased afterload
  • Aortic stenosis → increased afterload
  • Cardiomyopathies
  • Arrhythmias
55
Q

pre-load

A

stretch of ventricles before contraction

56
Q

after-load

A

what the heart has to pump againast

57
Q

classifying heart failure

A
  • left or right
    • reduced or preserved ejection fraction
58
Q

HfrEF

A

heart failure with reduced ejection fraction (most common)

  • → EF <40%
  • contractility problem
59
Q

HfpEF

A

preserved ejection fraction

  • filling problem-→ stiff and smaller ventricles
60
Q

right sided heart failure causes

A
  • CHRONIC hypoxia causing cor pulmonale
  • left sided HF
61
Q

left sided heart failure causes

A
  • IHD
  • MI
  • HTN
  • valvular
62
Q

right sided heart failure presentation

A
  • peripheral oedema
  • fatigue
  • distended jugular vein
63
Q

left sided heart failure presentation

A
  • pulmonary oedema
  • fatigue and tiredness
  • SoB
64
Q

acute coronary syndrome

A

doesnt include stable angina (pain on exercise

  • unstable angina
  • NSTEMI
  • STEMI
64
Q

acute coronary syndrome

A

doesnt include stable angina (pain on exercise

  • unstable angina
  • NSTEMI
  • STEMI
65
Q

unstable angina

A
  • pain on rest
  • normal Troponin
    • normal ECG
66
Q

NSTEMI

A
  • pain on rest
  • increased troponins
    • ECG either normal or ST depression
67
Q

STEMI

A
  • pain on rest
  • increased troponins
  • ECG- ST elevation
  • Q wave
68
Q

fostair

A

LABA and ICS

keep going even through exacerbation treatment

69
Q

what causes a visible JVP

A

pulmonary hypertension caused by chronic hypoxia

due to backlog in the pulmonary system reducing return via the superior vena cave due to increased pressure within the pulmonary system

70
Q

risperidone

A

antipsychotic

  • decreased dopaminergic and Serotonergic pathway
71
Q

kerley B lines

A

heart failure

72
Q

trimbow

A
  • antimuscarinic
  • steroid
  • SABA
73
Q

peak flow in asthma exacerbation

A

always take peak flow early in asthma exac. to ensure extent of constriction understood

  • if they dont have normal peak flow reading then use standardised chart to compare
74
Q

when to admit for COVID

A

sats <94%

will have low lymphocytes and eosinophols

75
Q

treatment of COVID-19

A
  • dexamethasone (which will increase BM so consider insulin for T2DM)
  • tocilizumab
  • covid antibodies-→ REGEN-COV
76
Q

which resp failure in MND

A

T2RF-→ low O2, high CO2

77
Q

subcutaenous (surgical) emphysema

A

e. g. when pt is tapped (pleural effusion) causing air from lungs to go into muscle -→ visible on X-ray
- → feels funny

78
Q

chronic pleural effusion

A

pleurodesis

  • talcon powder and saline
  • seals the pleura together
79
Q

how to measure extent of pneumothorax

A

measure rim of air from the hilum

If the lung edge measures more than 2 cm from the inner chest wall at the level of the hilum, it is said to be ‘large.’ If there is tracheal or mediastinal shift away from the pneumothorax, the pneumothorax is said to be under ‘tension.’ This is a medical emergency!

80
Q

diff between pacemaker and defib on x-ray

A

pacemaker- higher up

axilla- thicker wire

81
Q

upper lobe diversion

A

blood vessels same size of bronchioles

  • reflects elevation of left atrial pressure
  • early signs of pulmonary oedema
82
Q

covid-19 X-ray

A

patchy consolidation

bilateral

83
Q

primary ciliary dyskineasia (CF)

A
  • youngs
  • kartagener
84
Q

youngs

A

CF- bronchiectasis, sinusitis, reduced fertility

85
Q

kartagener

A

CF- bronchiectasis, sinusitis, situs inversus

86
Q

TB x-ray

A

found on upper lobe (more O2 for MTB)

ghon focus and caseating granuloma and complex (lymph)

Medicine block (Y3) (38 decks)

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