Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSRA > Respiratory + Cardiac > Flashcards

Respiratory + Cardiac Flashcards

1
Q

COPD:
- mild, moderate, severe and very severe % FEV1? (4)

A

> 80%
50-79%
30-49%
<30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Pneumothorax:
- when to follow up after drain/ aspiration? (1)
- flying? (1)
- deep sea diving (1)
- follow-up if conservative management for primary (1) and secondary (1)

A
  • follow-up after 2-4 weeks
  • can’t fly 2 weeks
  • NEVER
  • patients with a primary spontaneous pneumothorax that is managed conservatively should be reviewed every 2-4 days as an outpatient
  • secondary spontaneous pneumothorax that is managed conservatively should be monitored as an inpatient
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

COD:
- when to give NIV? (1)
- what type is used? (1)

A

Respiratory acidosis: pH 7.25-7.35

if pH < 7.25 –> HDU

BIPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CAP:
- discharge criteria (5)

A

NICE recommend that patients are not routinely discharged if in the past 24 hours they have had 2 or more of the following findings:

  • temperature higher than 37.5°C
  • respiratory rate 24 breaths per minute or more
  • heart rate over 100 beats per minute
  • systolic blood pressure 90 mmHg or less
  • oxygen saturation under 90% on room air
  • abnormal mental status
  • inability to eat without assistance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Asthma
- step-down steroids? (1)

A

In the step-down treatment of asthma, aim for a reduction of 25-50% in the dose of inhaled corticosteroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Asthma:
- gold standard diagnosis adults (1)
- test for 6-16 years (1)

A
  • FeNO test and spirometry with a bronchodilator reversibility test
    (should do once child 5 years)

5-16 years
- spirometry with bronchodilator reversibility (BDR) test and a FeNO test if normal spirometry or obstructive spirometry with negative bronchodilator reversibility test

<5 years
clinical judgement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

COPD:
- oxygen management (1)

A

still give HFNO if septic/ unwell

if not:
a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

COPD
- management (3)

A
  • SAMA or SABA
  • asthmatic= LABA+ICS (+SABA)
  • non-asthmatic= LABA+LAMA (+SABA)
  • LABA+LAMA+ICS (+SABA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

COPD
- what oral Abx prophlatic (1)
- pre-requisites to giving it (6)

A

azithromycin

  • don’t smoke
  • optimised standard therapy
  • continue to have exacerbations
  • CT throax (to exclude bronchiectasis)
  • sputum culture (to exclude atypical infections and tuberculosis)
  • LFTs and an ECG to exclude QT prolongation should also be done as azithromycin can prolong the QT interval
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

COPD infective exacerbation organism

A

haemophilus influenzae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

asthma management

A

SABA
SABA + ICS
SABA + low-dose ICS + leukotriene receptor antagonist (LTRA)

SABA + low-dose ICS + long-acting beta agonist (LABA)
Continue LTRA depending on patient’s response to LTRA

SABA +/- LTRA
Switch ICS/LABA for a maintenance and reliever therapy (MART), that includes a low-dose ICS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

prednsiolone and breastfeeding

A

safe

‘inhaled drugs, theophylline and prednisolone can be taken as normal during pregnancy and breast-feeding’.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Chest x-ray shows numerous parallel line shadows

A

bronchiectasis
(tram lines - indicate dilated bronchi due to peribronchial inflammation and fibrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Aspergilloma:
(a fungal growth)
- management (2)
- who does it impact (2)
- symptoms (3)

A
  • itraconazole and steroids
  • immunocompromised or people with underlying cavitationg disease e.g. TB/ emphysema

Symptoms of include fever, cough and haemoptysis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Aspergilloma XRAY

A

rounded opacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Granulomatosis with polyangiitis

A

A rare VASCULITIS in your nose, sinuses, throat, lungs and kidneys.

Upper respiratory tract: epistaxis, sinusitis, nasal crusting
Lower respiratory tract: dyspnoea, haemoptysis
Glomerulonephritis
Saddle-shape nose deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

which murmur causes haemoptysis

A

MITRAL STENOSIS:
Dyspnoea
Atrial fibrillation
Malar flush on cheeks
Mid-diastolic murmur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

COPD vaccinations (2)

A

annual influenza vaccination
one-off pneumococcal vaccination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CURB-65

A

C Confusion (abbreviated mental test score <= 8/10)
R Respiration rate >= 30/min
B Blood pressure: systolic <= 90 mmHg and/or diastolic <= 60 mmHg
65 Aged >= 65 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

when to repeat CXR post pneumonia

A

6 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

cut off for HTN age

A

55

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stage 2 HTN (when to start antihypertensives straight away)

A

Clinic = 160/100 +
Home= 150/95 mmHg +

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what drug is contraindicated in VT

A

verapamil

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

VT management

A

Shock if HISS

otherwise:
amiodarone: ideally administered through a central line
lidocaine: use with caution in severe left ventricular impairment
procainamide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

aortic stenosis in a fit person- what is the management?

A

Prosthetic heart valves - mechanical valves last longer and tend to be given to younger patients

older = bioprosthetic aortic valve replacement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

IVDU + IE = which valve?

A

tricuspid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

previous normal values + IE = which valuve

A

mitral valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

IE: which organism most common?

A

Staph aureus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

angina: appropriate prophylactic medication?

A

B blocker of CCB

if CCB alone= rate limiting (verapamil/ diltiazem)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what to add if stilll Sx after monotherapy for angina

A

a long-acting nitrate
ivabradine
nicorandil
ranolazine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

isosorbide mononitrate: tolerance

A

patients who take standard-release isosorbide mononitrate should use an asymmetric dosing interval to maintain a daily nitrate-free time of 10-14 hours to minimise the development of nitrate tolerance
this effect is not seen in patients who take once-daily modified-release isosorbide mononitrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

when to check U&E post ACEi

A

should be checked at baseline, 2 weeks after starting treatment and 2 weeks after each dose change. Once a maintenance dose has been established urea and electrolytes should be checked at 1, 3 and 6 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

early diastolic murmur

A

aortic regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

pansystolic murmur

A

mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

acute cause of aortic regurgitation

A

aortic dissection OR IE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pharmacological cardioversion

A

flecainide or amiodarone if there is no evidence of structural or ischaemic heart disease orc
amiodarone if there is evidence of structural heart disease.’

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

valve problem associated with polycystic kidney disease

A

mitral valve prolapse and mitral regurgitation being the most common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

ECG normal variants in athlete

A

sinus bradycardia
junctional rhythm
first degree heart block
Mobitz type 1 (Wenckebach phenomenon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

NSTEMI
After an ECG and troponin testing, he is diagnosed with non-ST segment elevation myocardial infarction (NSTEMI). You assess him using the GRACE score and his predicted 6-month mortality is 2%. He does not have a high risk of bleeding. The nearest primary percutaneous intervention unit is more than one hour away.

A

GRACE <3
aspirin + ticegralor

GRACE >3
aspirin + prasugrel + unfractionated heparin
+ PCI
+ drug eluting stent

ticagrelor, if not high bleeding risk
clopidogrel, if high bleeding risk

GRACE<3%
give ticegrelor

GRACE >3%
PCI if unstable. give prasugrel/ ticegrelor = unfractionated heparin + drug eluting stents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

AF + an acute stroke: when to start DOAC?

A

after 2 weeks
(anti platelet therapy intervening period)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

when to start DOAC after TIA for AF?

A

straight away

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

clopidogrel common drug ineraction

A

omeprazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

statin blood tests

A

LFTs baseline, 3 and 12 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

GTN side effects

A

Hypotension + tachycardia + headache

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Heart failure: what to do if unresponsive to IV loop diuretics and O2

A

CPAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Amioderone:
monitoring?

A

TFT, LFT, U&E, CXR prior to treatment
TFT, LFT every 6 months

A baseline chest x-ray is required due to the risk of pulmonary fibrosis / pneumonitis in patients treated with amiodarone. Urea and electrolytes are suggested by the BNF to detect hypokalaemia which may increase the risk of arrhythmias developing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Angina: when to refer to cardiology for PCI/ CABG? (1)

A

If on 3rd antianginal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

pregnancy and statin

A

AVOID

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Janeway lesions vs Oslers nodes

A

Janeway lesions are painless, erythematous haemorhagic lesions seen on the palms and soles. They are associated with infective endocarditis

Oslers nodes = OUCH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Warfarin management: major bleeding

A

Stop warfarin
Give intravenous vitamin K 5mg
Prothrombin complex concentrate - if not available then FFP*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Warfarin management: INR >8 and minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Repeat dose of vitamin K if INR still too high after 24 hours
Restart warfarin when INR < 5.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

warfarin management: INR >8 and no bleeding

A

Stop warfarin
Give vitamin K 1-5mg by mouth, using the intravenous preparation orally
Repeat dose of vitamin K if INR still too high after 24 hours
Restart when INR < 5.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

warfarin management: INR 5-8 minor bleeding

A

Stop warfarin
Give intravenous vitamin K 1-3mg
Restart when INR < 5.0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

warfarin management: no bleeding, INR 5-8

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

nicorandil (vasodilatory drum but NOT GTN)) side effects

A

headache
flushing
ANAL ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Left ventricular hypertrophy and deep ST depression and T-wave inversions consistent with what cardiac condition

A

HOCM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

HOCM:
inheritance? (1)
features? (5)

A

autosomal dominant

asymptomatic
exertion dypnoea
angina
syncope
sudden death (ventricular arrhythmias)
jerky pulse
systolic murmurs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

murmur with HOCM

A

mitral regurgitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

most common cause of sudden death In HOCM

A

ventricular arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Coarctation of the aorta

A

congenital narrowing or aorta

more common in men yet associated with Turners Sx

infancy: heart failure
adult: hypertension
radio-femoral delay
mid systolic murmur, maximal over the back
apical click from the aortic valve
notching of the inferior border of the ribs (due to collateral vessels) is not seen in young children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Off driving after CABG?

A

4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

off driving after ACS

A

4 weeks - down to 1 week if successful angioplasty

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

U waves

A

Hypokalaemia
hypocalcaemia
hypothermia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

when is third heart sounds normal?

A

<30 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

HOCM what medication to avoid

A

nitrates
ACE-inhibitors
inotropes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

management HOCM

A

Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. The estimated prevalence is 1 in 500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

management WPW syndrome

A

definitive treatment: radiofrequency ablation of the accessory pathway
medical therapy: sotalol***, amiodarone, flecainide
sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

what is WPW associated with

A

HOCM
mitral valve prolape
Abstains anomaly
thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

short PR, palpitations post exercise

A

WPW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

regular, low-volume pulse and a mid-diastolic murmur loudest with the patient leaning to his left-hand side.

A

mitral stenosis (P mitrale)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

heart failure:
CXR signs

A

Alveolar oedema (bat’s wings),
Kerley B lines (interstitial oedema),
Cardiomegaly, Dilated prominent upper lobe vessels,
Effusion (pleural) are features of heart failure on a chest x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Surgery for bronchiectasis

A

only is localised disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

most common organism infection bronchiectasis

A

Haemophilus influenzae (most common)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Azithromycin:
before starting what should patient have? (4)

A

CT thorax, ECG, liver function testing, and sputum cultures.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Berylliosis

A

condition is caused by exposure to beryllium dust. This is almost always an occupational exposure and is seen in workers of the electronics and metal extraction industries.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Mantoux test is for..

A

TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Lung volume reduction surgery

A

removes the worst affected part of the lungs in order to improve airflow and alveolar gas exchange in the remaining portion of the lung.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Alpha-1 antitrypsin deficiency

A

no smoking
supportive: bronchodilators, physiotherapy
intravenous alpha1-antitrypsin protein concentrates
surgery: lung volume reduction surgery, lung transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Nicotine replacement:
what other medications can you try? (2)
how long to prescribe for? (1)
when to offer repeat? (1)

A
  • varenicline or bupropion
  • until 2 weeks after the target stop date.
  • if unsuccessful, don’t offer another until 6 months unless they’re demonstrated they are going to stop
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Bupropion:
- how does it work? (1)
- what is it used for? (1)
- contraindications (3)

A

norepinephrine-dopamine reuptake inhibitor and nicotinic antagonist
an antidepressant used for smoking cessation
SEIZURES, pregnancy/ breast feeding
start 2 weeks before quitting

80
Q

Varenicline:
how does it work? (1)
side effects? (2)

A
  • nicotine receptor agonist
  • varenicline should be used with caution in patients with a history of depression or self-harm. There are ongoing studies looking at the risk of suicidal behaviour in patients taking varenicline
  • SE: nausea is the most common adverse effect. Other common problems include headache, insomnia, abnormal dreams
81
Q

Pregnany and smoking

A

all pregnant women should be tested for smoking using carbon monoxide detectors, partly because ‘some women find it difficult to say that they smoke because the pressure not to smoke during pregnancy is so intense.

82
Q

Mining occupation, upper zone fibrosis, egg-shell calcification of hilar nodes

A

Silicosis

83
Q

pneumoconiosis

A

a class of lung disease characterised by inhalation of (usually occupational) dust.

84
Q

swinging fevers, night sweats, pleuritic chest pain, dyspnoea, and cough

A

lung abscess

85
Q

Most common cause lung abscess

A

secondary to aspiration pneumonia

86
Q

Treatment abscess if Abx failed?

A

Percutaneous drainage should be considered if a lung abscess is not improving with intravenous antibiotics

87
Q

Difference presentation abscess vs pneumonia

A

Sx develop subacute (over weeks)

88
Q

Pneumonia + upper lobe+ diabetic/alcoholic

A

Klebsiella pneumonia

Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics

red currant jelly sputum

89
Q

an atypical pneumonia that commonly spreads via a contaminated water supply (e.g. air conditioner vents). Common symptoms include fever, cough and myalgia. Bilateral chest symptoms are more common and other extra-pulmonary symptoms (e.g. hyponatraemia and hepatitis) are seen.

A

legionella

90
Q

an atypical pneumonia with symptoms including coryza and a dry cough. This form of pneumonia is associated with extra-pulmonary symptoms such as haemolytic anaemia and erythema multiforme that are not seen here.

A

Mycoplasma pneumonia

91
Q

most common cause of community-acquired pneumonia with symptoms including a classical history of fever, productive cough and shortness of breath.

A

Strep pneumoniae

92
Q

Asthma:
cannot complete sentences

A

severe asthma

93
Q

Asthma:
RR>25
HR >110

A

severe asthma

94
Q

Asthma: PEFR 33-50%

A

severe

95
Q

ASthma: PEFR <33%

A

life threatening

96
Q

Asthma: Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

A

life threatening

97
Q

What is a near Fatal asthma attack?

A

raised pC02 and/or requiring mechanical ventilation with raised inflation pressures.

98
Q

When to do CXR in asthma?

A

if:
- suspected penumonothorax
- failed to respond to treatment
- life-threatening asthma

99
Q

Asthma:
when to discharge? (3)

A

been stable on their discharge medication (i.e. no nebulisers or oxygen) for 12-24 hours
inhaler technique checked and recorded
PEF >75% of best or predicted

100
Q

COPD:
thresholds for severity of Stage 1-4? (4)

A

> 80% (mild - Stage 1)
50-79% (moderate)
30-49% (sever)
<30% (very severe - Stage 4)

101
Q

COPD + peripheral oedema, raised jugular venous pressure, systolic parasternal heave, loud P2 - what is it? (1)
treatment (2)

A

cor pulmonale

can consider loop diuretic or LTOT

102
Q

Factors improving COPD survival? (3)

A

smoking cessation - the single most important intervention in patients who are still smoking
long term oxygen therapy in patients who fit criteria
lung volume reduction surgery in selected patients

103
Q

Anterior mediastinal mass (4)

A

4 T’s: teratoma, terrible lymphadenopathy, thymic mass and thyroid mass

104
Q

Pneumothorax:
when safe to fly?

A

2 weeks after if no residual air

105
Q

Pneumothorax treatment if asymptomatic?

A

conservative care regardless of side

106
Q

Pneumothorax:
if symptomatic, what is the next step in assessment? (1)
feature (6)
what to do? (1)

A
  1. Symptomatic VS not
    if SYMMPOTOMATIC –> process to step 2
    if NOT –> no treatment
  2. HIGH RISK?
    haemodynamic compromise (suggesting a tension pneumothorax)
    significant hypoxia
    bilateral pneumothorax
    underlying lung disease
    ≥ 50 years of age with significant smoking history
    haemothorax
    if HIGH RISK –> CHEST DRAIN
    if NOT HIGH RISK –> choice
107
Q

if no high risk features but symptomatic pneumothorax?

A

if no high-risk characteristics are present, and it is safe to intervene, then there is a choice of intervention:
conservative care
ambulatory device
needle aspiration

108
Q

How to know a chest drain or aspiration is safe?

A

2cm laterally or apically on CXR

OR

any size on CT scan

109
Q

Pneumothorax follow-up:
Conservative management spontaneous pneumothorax- when to review? (1)
needle aspiration (1)
chest drain (1)

A

every 2-4 days for conservative
aspiration: after 2-4 weeks (if failed then do chest drain)
drain: daily r/v as IP then 2-4weeks post discharge

110
Q

pleural plaques follow-up

A

Pleural plaques are the most common form of asbestos-related lung disease and are benign. They are not associated with an increased risk of lung cancer or mesothelioma. This patient should be reassured and advised that no follow-up of these specific plaques is necessary, although an ongoing review of his lung disease is encouraged.

111
Q

Most common cause of asbestos in the lung

A

pleural plaque

112
Q

Asbestos:
lung problems

A

plural plaques
pleural thickening
asbestosis
mesothelioma

113
Q

management mesothelioma (1)

A

palliative chemotherapy

terrible prognosis
limited role of surgery or radiotherapy

114
Q

most common cancer in asbestos exposure

A

LUNG cancer (not mesothelioma!)

115
Q

BiPAP: what type of respiratory failure due it help? (1)

A

Type 2 resp failure

116
Q

Lung cancer:
small cell

A

arise from APUD* cells
associated with ectopic ADH, ACTH secretion
ADH → hyponatraemia
ACTH → Cushing’s syndrome
ACTH secretion can cause bilateral adrenal hyperplasia, the high levels of cortisol can lead to hypokalaemic alkalosis
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome

117
Q

The combination of pulmonary haemorrhage (haemoptysis), renal impairment (rapidly progressive glomerulonephritis) and flat or saddle nose (due to a collapse of the nasal septum)

A

is characteristic of granulomatosis with polyangiitis.

118
Q

Chest tube placement critiera

A

Patients with frankly purulent or turbid/cloudy pleural fluid on sampling should receive prompt pleural space chest tube drainage.
The presence of organisms identified by Gram stain and/or culture from a non-purulent pleural fluid sample indicates that pleural infection is established and should lead to prompt chest tube drainage.
Pleural fluid pH < 7.2 in patients with suspected pleural infection indicates a need for chest tube drainage.

119
Q

Lights criteria: What signifies an exudate? (1)

A

PROTEIN:
This can sometimes be ascertained quite easily by looking at the protein content of the pleural fluid (transudate protein content < 25g/L and exudate protein content > 35g/L)

LDH: (if uncertain)
Effusion LDH level greater than 2/3rds the upper limit of serum LDH points to exudate

120
Q

Pleural aspiration:
what needle used? (1)
what is examined in the fluid (4)
what imaging used? (1)

A

a 21G needle and 50ml syringe should be used
fluid should be sent for pH, protein, lactate dehydrogenase (LDH), cytology and microbiology

US recomended to reduce complication rate

121
Q

what signfies pleural infection in fluid sampling?

A

pH < 7.2

122
Q

Effusion fluids
low glucose (2)
raised amylase? (2)
blood staining (3)

A

low glucose: rheumatoid arthritis, tuberculosis
raised amylase: pancreatitis, oesophageal perforation
heavy blood staining: mesothelioma, pulmonary embolism, tuberculosis

123
Q

reducing steroid inhaler of 200BD

A

reduce to 200OD
(Not 100 BD)

124
Q

bupropion contraindication

A

epilepsy

125
Q

fungal growth affecting immunocompromised patients or those with underlying cavitating lung disease such as tuberculosis or emphysema. Symptoms of include fever, cough and haemoptysis. Treatment is with anti fungal medications such as itraconazole.

A

aspergilloma

126
Q

statin bloods monitoring

A

LFT at baseline, 3 months and 12 months

126
Q

cut off for Type 2 HTN (when to start treatment at diagnosis )

A

Stage 1 hypertension is defined by an ABPM reading of >= 135/85 mmHg, with stage 2 hypertension having a cut-off of >= 150/95 mmHg.

126
Q

PESI score

A

used to help identify patients with a pulmonary embolism that can be managed as outpatients

127
Q

alternative mineralcorticoid receptor antagonist to spirolactone in heart failure

A

eplerenone

(1st line= ACEi+BB,
2nd= aldosterone antagonist / mineralocorticoid receptor antagonist *monitor K+)
consider SGLT2 if reduced EF

127
Q

Concurrent use of which drug may make clopidogrel less effective?

A

omeprazole

127
Q

post STEMI meds

A

A
B
C
Dual anti platelets (one of which aspirin)
aspirin

128
Q

when to check U&E in ACEi

A

, 2 weeks after starting treatment and 2 weeks after each dose change. Once a maintenance dose has been established urea and electrolytes should be checked at 1, 3 and 6 months.

129
Q

Statins + erythromycin/clarithromycin

A

an important and common interaction –> myopathy

130
Q

management HOCM

A

Hypertrophic obstructive cardiomyopathy (HOCM) is an autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins. The estimated prevalence is 1 in 500.

Management
Amiodarone
Beta-blockers or verapamil for symptoms
Cardioverter defibrillator
Dual chamber pacemaker
Endocarditis prophylaxis*

131
Q

what drug to avoid HOCM

A

ACEi

132
Q

27 yo. On examination, he had a midsystolic murmur heard best at the left lower sternal border. It was louder with the Valsalva manoeuvre. An echocardiogram reported mitral regurgitation, systolic anterior motion of the anterior mitral valve leaflet, asymmetric hypertrophy and left ventricular outflow tract obstruction.

A

HOCM

133
Q

When to treat stage 1 HTN

A

treat if <80yo and any of:
Target organ damage
Established cardiovascular disease
Renal disease
Diabetes
10yr CVD risk >=10% (QRISK)

134
Q

how long to wait to take sildenafil post STEMI

A

6 months

135
Q

‘notching of the inferior border of the ribs’ and HTN in young person

A

coarctation of the aorta. The aortic obstruction gives rise to the development of dilated intercostal collateral vessels to allow sufficient blood flow to reach the descending aorta. The pressure of these vessels erodes the inferior margin of the ribs. Coarctation also explains this patient’s refractory hypertension.

136
Q

shortened PR interval and wide QRS complexes associated with a slurred upstroke seen in lead II

A

Wolff-Parkinson White
caused by a congenital accessory conducting pathway between the atria and ventricles leading to atrioventricular re-entry tachycardia (AVRT). As the accessory pathway does not slow conduction AF can degenerate rapidly to VF.

Management
definitive treatment: radiofrequency ablation of the accessory pathway
medical therapy: sotalol***, amiodarone, flecainide
sotalol should be avoided if there is coexistent atrial fibrillation as prolonging the refractory period at the AV node may increase the rate of transmission through the accessory pathway, increasing the ventricular rate and potentially deteriorating into ventricular fibrillation

137
Q

Infective endocarditis most common causes

A

Gram positive cocci (Common causes:
Streptococcus viridans
Staphylococcus aureus (in intravenous drugs uses or prosthetic valves)
Staphylococcus epidermidis (in prosthetic valves)

138
Q

Has only been demonstrated to improve mortality in patients with NYHA class III or IV heart failure who are already taking an ACE inhibitor

A

spirolactone

139
Q

anti anginals

A

BB or Ca2+ CB (verapamil)

+ aspirin
+ simvastatin

140
Q

nicorandil

A

Nicorandil is a vasodilatory drug used to treat angina. It is a potassium-channel activator with vasodilation is through activation of guanylyl cyclase which results in increase cGMP.

Adverse effects
headache
flushing
skin, mucosal and eye ulceration
gastrointestinal ulcers including anal ulceration

Contraindications
left ventricular failure

141
Q

Verapamil should be avoided in patients with

A

HF

142
Q

what is GRACE calculated on

A

The doctor is calculating the 6-month mortality using a GRACE score - this includes age, ECG, troponin, renal function.

143
Q

ECG changes in mitral stenosis

A

P Mitrale represents left atrial hypertrophy/strain e.g. in mitral stenosis

144
Q

best test for addisons

A

short synachten test

145
Q

investigation for secondary hypoparathyroidsim

A

MRI brain - Secondary hypothyroidism is caused by pituitary failure and needs imaging

146
Q

how to gliptins work

A

Gliptins (DPP-4 inhibitors) reduce the peripheral breakdown of incretins such as GLP-1

147
Q

OGTT readings

A

fasting >7 and has polyuria, polydipsia, or other symptoms, we diagnose diabetes.

If BMs >6.1 but <6.9, we call them as having impaired fasting glucose and offer them OGTT.

  1. On OGTT, if the fasting glucose is <7 and the OGTT 2-hour value is =/>7.8 but <11, we call them to have Impaired glucose tolerance and offer lifestyle advice and call them prediabetic.
148
Q

viral thyroiditis

A

= subacute thyroiditis = de Quervain’s

149
Q

Subacute thyroiditis vs haeimoaos thyoritisi

A

raised ESR in subacute

150
Q

ADDisosn is Hypo or hyperaldosteronism

A

HYPO

151
Q

digoxin vs cardiac resynchronisation therapy in HF

A

In symptomatic heart failure patients who are on optimal medical therapy, there are several treatment options to improve mortality. Cardiac resynchronisation therapy is indicated in patients with left ventricular dysfunction, ejection fracture <35% and QRS duration >120ms. An Implantable cardiac defibrillator (ICD) is indicated in patients with previous sustained ventricular tachycardia, ejection fraction <35% and symptoms no worse than class III of of the New York Heart Association functional classification.

Digoxin reduces hospitalisation but not mortality in heart failure. Increasing the furosemide dose may help with symptomatic relief from fluid overload but has no effect on mortality. Heart transplantation and ventricular assist devices would not be an option in a patient of this age.

152
Q

A 39-year-old man presents with headaches and excessive sweating. He also reports some visual loss. Visual fields testing reveals bitemporal hemianopia.

A

Acromegaly 50%

Features of acromegaly include:
coarse facial appearance, spade-like hands, increase in shoe size
large tongue, prognathism, interdental spaces
excessive sweating and oily skin
features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia

153
Q

3rd antihypertensive cut off (1)
what else to consider?

A

K+ 4.5

<4.5 –> SPIROLACTONE
> 4.5mmol/l - add an alpha- or beta-blocker

NICE also suggests seeking specialist advice and discussing adherence with patients in these cases. Patients should also be assessed for postural hypotension (this can be done by measuring lying to standing blood pressure).

154
Q

When should you NOT use DOAC for VTE?

A

eGFR <15 (renal impairment)
antiphospholipid synrome

LMWH followed by warfarin

155
Q

Hypokalaemia ECG

A

U waves
small or absent T waves (occasionally inversion)
prolong PR interval
ST depression
long QT

156
Q

SVT management if vagal manoeuvres failed (1)
when to NOT give (1)

A

rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg
contraindicated in asthmatics - verapamil is a preferable option

157
Q

Third heart sound casues

A

<30 = physiological

> 30 = heart failure (heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation)

158
Q

1st line management low severity CAP

A

amoxicillin 5/7

159
Q

1st line management moderate to severe severity CAP

A

dual Abx therapy amoxicillin and macrolide
7-10/7

160
Q

Mesothelioma vs asbestosis

A

Asbestosis: severity of asbestosis is related to the length of exposure, doesn’t cause a mass

Mesothelioma: cancer of the mesothelial layer of the pleural cavity , only limited exposure needed, causes a mass

161
Q

treatment for regular broad complex tachycardias without adverse features

A

REGULAR = IV amiodarone (loading dose of amiodarone followed by 24 hour infusion)

IRREGULAR = seek expert help ?Torsade de pointes/ AF with odd rhythms

162
Q

1st line treatment COPD

A

SABA or SAMA (ipratropium)

163
Q

Formoterol and salmeterol are examples of

A

LABA

164
Q

Tiotropium is a…

A

LAMA ( used as a second-line treatment for COPD (alongside a LABA) in patients with no features of asthma/steroid responsiveness.)

165
Q

Shockable rhythms

A

pulseless VT
VF

166
Q

when to give 3 successive shocks before comencing CPR

A

if the cardiac arrested is witnessed in a monitored patient (e.g. in a coronary care unit) then the 2015 guidelines recommend ‘up to three quick successive (stacked) shocks’, rather than 1 shock followed by CPR

167
Q

Pericarditis vs Dressler’s

A

Pericarditis in the first 48 hours following a transmural MI is common (c. 10% of patients). The pain is typical for pericarditis (worse on lying flat etc), a pericardial rub may be heard and a pericardial effusion may be demonstrated with an echocardiogram.

Dressler’s syndrome tends to occur around 2-6 weeks following a MI. The underlying pathophysiology is thought to be an autoimmune reaction against antigenic proteins formed as the myocardium recovers. It is characterised by a combination of fever, pleuritic pain, pericardial effusion and a raised ESR. It is treated with NSAIDs.

168
Q

life threatening asthma attack

A

PEFR < 33% best or predicted
Oxygen sats < 92%
‘Normal’ pC02 (4.6-6.0 kPa)
Silent chest, cyanosis or feeble respiratory effort
Bradycardia, dysrhythmia or hypotension
Exhaustion, confusion or coma

169
Q

A 66-year-old woman suddenly develops dyspnoea 10 days after having an anterior myocardial infarction. Her blood pressure is 78/50 mmHg, JVP is elevated and the heart sounds are muffled. There are widespread crackles on her chest and the oxygen saturations are 84% on room air.

A

left ventricular free wall rupture

170
Q

side effects beta blockers

A

bronchospasm
cold peripheries
fatigue
sleep disturbances, including nightmares
erectile dysfunction

171
Q

contraindications of beta blockers

A

uncontrolled heart failure
asthma
sick sinus syndrome
concurrent verapamil use: may precipitate severe bradycardia

172
Q

Tachycardia - HISS features:
how many times to shock? (1)
what do try after? (1)

A

3 times

if failed:
- amiodarone 300mg IV over 10-20mins
- repeat synchronised DC shocks

173
Q

STEMI: when to offer fibrinolysis

A

within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes

174
Q

STMI: what to do it PCI available with 120mins

A

give praugrel

give unfractionated heparin + bailout glycoprotein

drug eluting stems used in preference

175
Q

PCI: what to do if patient presenting >12hr post symptom starting

A

consider PCI if cariogenic shock/ ongoing myocardial ischaemia

176
Q

Cr increase in ACEi acceptable

A

<30%

177
Q

what causes LOWER BNP levels

A

ALL HEART DRUGS + BMI

Obesity
Diuretics
ACE inhibitors
Beta-blockers
Angiotensin 2 receptor blockers
Aldosterone antagonists

178
Q

interpreting BNP

A

if levels are ‘high’ arrange specialist assessment (including transthoracic echocardiography) within 2 weeks
if levels are ‘raised’ arrange specialist assessment (including transthoracic echocardiography) echocardiogram within 6 weeks

179
Q

what causes higher BNP reading

A

Left ventricular hypertrophy
Ischaemia
Tachycardia
Right ventricular overload
Hypoxaemia (including pulmonary embolism)
GFR < 60 ml/min
Sepsis
COPD
Diabetes
Age > 70
Liver cirrhosis

180
Q

dihydropyridine CCB

A

nifedipine or amlodipine

181
Q

AF when can you reverse

A

<48hr

If the atrial fibrillation (AF) is definitely of less than 48 hours onset patients should be heparinised. Patients who have risk factors for ischaemic stroke should be put on lifelong oral anticoagulation. Otherwise, patients may be cardioverted using either:

electrical - ‘DC cardioversion’
pharmacology - amiodarone if structural heart disease, flecainide or amiodarone in those without structural heart disease

Following electrical cardioversion if AF is confirmed as being less than 48 hours duration then further anticoagulation is unnecessary

182
Q

AF >48HR reversal

A

If the patient has been in AF for more than 48 hours then anticoagulation should be given for at least 3 weeks prior to cardioversion. An alternative strategy is to perform a transoesophageal echo (TOE) to exclude a left atrial appendage (LAA) thrombus. If excluded patients may be heparinised and cardioverted immediately.

NICE recommend electrical cardioversion in this scenario, rather than pharmacological.

If there is a high risk of cardioversion failure (e.g. Previous failure or AF recurrence) then it is recommend to have at least 4 weeks amiodarone or sotalol prior to electrical cardioversion

Following electrical cardioversion patients should be anticoagulated for at least 4 weeks. After this time decisions about anticoagulation should be taken on an individual basis depending on the risk of recurrence

183
Q

restrictive lung diseases

A

Pulmonary fibrosis
Asbestosis
Sarcoidosis
Acute respiratory distress syndrome
Infant respiratory distress syndrome
Kyphoscoliosis e.g. ankylosing spondylitis
Neuromuscular disorders
Severe obesity

184
Q

admission criteria in asthma

A
  • life threatening features
  • previous near fatal attack
  • pregnant
    presentation at night when already using oral corticosteroids
185
Q

acute pericarditis causes

A

inflammation of the pericardial sac, lasting for less than 4-6 weeks.

Aetiology
viral infections (Coxsackie)
tuberculosis
uraemia
post-myocardial infarction
early (1-3 days): fibrinous pericarditis
late (weeks to months): autoimmune pericarditis (Dressler’s syndrome)
radiotherapy
connective tissue disease
systemic lupus erythematosus
rheumatoid arthritis
hypothyroidism
malignancy
lung cancer
breast cancer
trauma

186
Q

acute pericardidits investigations for all

A

Transthoracic Echo

bloods
- inflammatory markers
- troponin: around 30% of patients may have an elevated troponin - this indicates possible myopericarditis

187
Q

idiopathic or viral pericarditis first line treatment (2)

A

NSAIDs and colchicine

avoid evercise until symptoms resolved

188
Q

when to admit acute pericarditis (1)

A

ADMIT if >38oC / elevated trop/ unwell

189
Q

if pt having STEMI goes for PCI, what else should they get

A

apririn
clopidogren
IV heparin ( intravenous unfractionated heparin for anticoagulation during the procedure)

190
Q

What to do after thrombolysis of STEMI

A

An ECG should be performed 90 minutes following thrombolysis to assess whether there has been a greater than 50% resolution in the ST elevation
if there has not been adequate resolution then rescue PCI is superior to repeat thrombolysis
for patients successfully treated with thrombolysis PCI has been shown to be beneficial. The optimal timing of this is still under investigation

191
Q

Gylcaemic control in STEMI

A
  • dose-adjusted insulin infusion with regular monitoring of blood glucose levels to glucose below 11.0 mmol/l
  • intensive insulin therapy (an intravenous infusion of insulin and glucose with or without potassium, sometimes referred to as ‘DIGAMI’) regimes are not recommended routinely
192
Q

If atropine fails, what is next for symptomatic bradycardia

A

External (transcutaneous) pacing

Atropine 500mg
isoprenaline 5mcg
adrenaline 2-10mcg
alternative

193
Q

ST depression in a few leads

A

posterior MI

194
Q
A

MSRA (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions