Pink summary book 2/3 Flashcards
general tips for X-rays
- dont be too specific
- opacification not consolidation
- zones not lobes
CXR presentation
ABCDE
- Confirm pt details
- Quality of image (rotation, inspiration, projection, exposure)
- Airway (central trachea, carina and bronchi)
- Breathing/bones (lung zones, opacification, absence of lung markings, pleura, meniscus sign, fracture/lytic lesions)
- Cardiac/circulation (Hilar structures, heart size, heart borders)
- Diaphragm (L= gas from stomach, R= higher up due to liver, flattened, costophrenic angles)
- Everything else (aortic knuckles, aortic pulmonary window, soft tissue, tubes, valves and pacemaker)
what can cause a deviated trachea
Pathology
- pulled→ atelectasis
- pushed → pneumo and pleural effusion
Rotation of pt
opacification sign of
infection/ cancer / fluid
calcification of hilar vessels due to
calcification
bilateral enlargement of hilar structures
sarcoidosis
causes of blunted costophrenic angles
fluid
consolidation
COPD
causes of blunted costophrenic angles
fluid
consolidation
COPD
review areas on x-ray
- lung apices (TB and batwing sign)
- retrocardiac region
- behind diaphragm
- peripheral region of lungs
- hilar regions
- situs invertus
ECG presentation
- Confirm patients details
- regular or irregular
- heart rate
- heart rhythm
- sinus? P waves before each QRS
- cardiac axis
7.
regular or irregular
use paper to see spacing
heart rate
- tachy or brady?
- regular- 300/ no. of boxes R-R
- irregular- no. of QRS in rhythm strip x6
heart rhythm
regular
regularly irregular
irregularly irregular
heart rhythm
regular
regularly irregular
irregularly irregular
Sinus
- regular rhythm
- always p waves inf ront of QRS
P waves
- sawtooth- flutter
- chaotic- fib
- flat- no atrial activity
which leads to look at for cardiac axis
- Look at limb leads only (II, AVL, III)
Normal axis
- lead II most positive
Left axis deviation
- AVL most positive
Right axis deivation
lead III most positive
PR intevral
120-220ms
-
prolonged if >0.2s
- AV delay e.g. heartblock
-
shortened
- accessory pathway
QRS
narrow <0.12
wide >0.12
tall= ventricular hypertrophy
QRS morphology
- delta waves
- Q waves
- R waves
- S waves
- J point segment
delta waves
slurred upstroke e.g. wolf-P-W
Q waves
previous MI
ST segment
should be isoelectric
- ST elevation- full thickness ischaemia
- ST depression- ischaemia
T waves
- tall= ‘tented’
- hyperkalaemia
-
hyperacute
- STEMI
-
inverted
- ischaemia
- BBB
- PE
-
biphasic
- ischamia
- hypokalamia
-
flattened
- ischaemia
U wave
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.
causes of atrial fibrillation
- ismchaemic heart disease
- mitral valve disease
- thyrotoxicosis
causes of atrial fibrillation
- ismchaemic heart disease
- mitral valve disease
- thyrotoxicosis
thyrotoxicosis
exopthalmos
low BP
increased sympathetic drive i.e. AF
treatment of AF when patient is haemodynamically stable
- Anticoagulation to prevent stroke - DOAC
- Rate control - B- blocker or digoxin
If patient is not haemodynamically stable
- Rhythm control- Cardioversion
DOACs
- 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
Triggers of AF
*
- Binge drinking
- Obesity
- Cocaine ad amphetamines
People with AF are at risk of
- Cardioembolic stroke- due to stasis of blood in the atria
- Cardiac instability
- And higher risk of death
- Increased healthcare cost
Diagnosis of AF
- Pulse- irregularly irregular
- Symptoms
- Breathlessness
- Palpitations
- Syncope/dizziness
- Chest discomfort
- Stroke or TIA
- ECG
- Echcardiogram
pulmonary embolisms investigations
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
with PE always think
could be cancer
massive PE will result in
reduced BP → thrombolyse
when to anticoagulate
risk benefit
compare risk of bleeding (HAS-BLED) with risk of clot (CHA2DS2VaSc)
vocal resonance can be measured on
auscultation or on palpation
increased vocal resonance
due to increased consolidation (Solid) -→ pneumonia
decreased vocal resonance
due to increased fluid = liquid e.g. pleural effusion
air bronchogram
air filled bronchi made clear by opacification of surrounding alveoli i.e. in pneumonia
AKI blood test results and treatment
increased creatinine and urea
give fluids
why ask about birds/ parots
atypical pneumonia e.g. chlamydia psittacosis
batwing distribution on X-ray
pulmonary oedema
- apical and basal sparing due to fluid leaving from the hilum (middle zones)
- give furosemide
MI basic treatment
MONA
- morphine
- oxygen (only if below 94%)
- nitrate (GTN)
- aspirin (STAT- 300mg)
then PCI-→ consider clopidogrel in prpe
prinzmental angina
vasospastic angina that occurs at rest
causes of COPD exacerbation
- recent decrease in diuretics
- infection
define heart failure
inability of the the heart to meet the demands of the bod
heart failure basic treatment
BAD
Beta blockers
ACEi
Diuretics
what makes sure the heart pumps effectively
- one way valve -→ blood goes in one direction
- chamber size-→ if too small reduced preload
- functioning muscle
causes of HF
- Ischaemic heart disease-→ remodelling due to fibrosis after ischaemia
- HTN→ increased afterload
- Aortic stenosis → increased afterload
- Cardiomyopathies
- Arrhythmias
pre-load
stretch of ventricles before contraction
after-load
what the heart has to pump againast
classifying heart failure
- left or right
- reduced or preserved ejection fraction
HfrEF
heart failure with reduced ejection fraction (most common)
- → EF <40%
- contractility problem
HfpEF
preserved ejection fraction
- filling problem-→ stiff and smaller ventricles
right sided heart failure causes
- CHRONIC hypoxia causing cor pulmonale
- left sided HF
left sided heart failure causes
- IHD
- MI
- HTN
- valvular
right sided heart failure presentation
- peripheral oedema
- fatigue
- distended jugular vein
left sided heart failure presentation
- pulmonary oedema
- fatigue and tiredness
- SoB
acute coronary syndrome
doesnt include stable angina (pain on exercise
- unstable angina
- NSTEMI
- STEMI
acute coronary syndrome
doesnt include stable angina (pain on exercise
- unstable angina
- NSTEMI
- STEMI
unstable angina
- pain on rest
- normal Troponin
- normal ECG
NSTEMI
- pain on rest
- increased troponins
- ECG either normal or ST depression
STEMI
- pain on rest
- increased troponins
- ECG- ST elevation
- Q wave
fostair
LABA and ICS
keep going even through exacerbation treatment
what causes a visible JVP
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
risperidone
antipsychotic
- decreased dopaminergic and Serotonergic pathway
kerley B lines
heart failure
trimbow
- antimuscarinic
- steroid
- SABA
peak flow in asthma exacerbation
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
when to admit for COVID
sats <94%
will have low lymphocytes and eosinophols
treatment of COVID-19
- dexamethasone (which will increase BM so consider insulin for T2DM)
- tocilizumab
- covid antibodies-→ REGEN-COV
which resp failure in MND
T2RF-→ low O2, high CO2
subcutaenous (surgical) emphysema
e. g. when pt is tapped (pleural effusion) causing air from lungs to go into muscle -→ visible on X-ray
- → feels funny
chronic pleural effusion
pleurodesis
- talcon powder and saline
- seals the pleura together
how to measure extent of pneumothorax
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!
diff between pacemaker and defib on x-ray
pacemaker- higher up
axilla- thicker wire
upper lobe diversion
blood vessels same size of bronchioles
- reflects elevation of left atrial pressure
- early signs of pulmonary oedema
covid-19 X-ray
patchy consolidation
bilateral
primary ciliary dyskineasia (CF)
- youngs
- kartagener
youngs
CF- bronchiectasis, sinusitis, reduced fertility
kartagener
CF- bronchiectasis, sinusitis, situs inversus
TB x-ray
found on upper lobe (more O2 for MTB)
ghon focus and caseating granuloma and complex (lymph)
