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MSRA > Respiratory + Cardiac + Endo > Flashcards

Respiratory + Cardiac + Endo Flashcards

1
Q

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

A

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

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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
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2
Q

COD:
- when to give NIV? (2)

A

typically used for COPD with respiratory acidosis pH 7.25-7.35
the BTS guidelines state that NIV can be used in patients who are more acidotic (i.e. pH < 7.25) but that a greater degree of monitoring is required (e.g. HDU) and a lower threshold for intubation and ventilation should be used
bilevel positive airway pressure (BiPaP) is typically used with initial settings:
Expiratory Positive Airway Pressure (EPAP): 4-5 cm H2O
Inspiratory Positive Airway Pressure (IPAP): RCP advocate 10 cm H20 whilst BTS suggest 12-15 cm H2O

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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.
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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

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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

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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

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7
Q

COPD
- management (3)

A
  • SAMA or SABA
  • asthmatic= LABA+ICS (+SABA)
  • non-asthmatic= LABA+LAMA (+SABA)
  • LABA+LAMA+ICS (+SABA)
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8
Q

COPD
- oral prophylactic therapy pre-requisites

A

azithromycin prophylaxis is recommended in select patients
patients should not smoke, have optimised standard treatments and continue to have exacerbations
other prerequisites include a CT thorax (to exclude bronchiectasis) and 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

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9
Q

COPD infective exacerbation organism

A

haemophilus influenzae

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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

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11
Q

prednsiolone and breastfeeding

A

safe

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

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12
Q

Chest x-ray shows numerous parallel line shadows

A

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

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13
Q

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

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

Symptoms of include fever, cough and haemoptysis.

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14
Q

Aspergilloma XRAY

A

rounded opacity

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15
Q

Granulomatosis with polyangiitis

A

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

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16
Q

which murmur causes haemoptysis

A

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

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17
Q

COPD vaccinations (2)

A

annual influenza vaccination
one-off pneumococcal vaccination

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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

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19
Q

when to repeat CXR post pneumonia

A

6 weeks

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20
Q

cut off for HTN age

A

55

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21
Q

Stage 2 HTN (when to start antihypertensives straight away)

A

Clinic blood pressure is 160/100 mmHg or higher and subsequent ambulatory blood pressure daytime average or home blood pressure monitoring average blood pressure is 150/95 mmHg or higher

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22
Q

what drug is contraindicated in VT

A

verapamil

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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

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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

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25
Q

IVDU + IE = which valve?

A

tricuspid

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26
Q

previous normal values + IE = which valuve

A

mitral valve

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27
Q

IE: which organism most common?

A

Staph aureus

28
Q

angina: appropriate prophylactic medication?

A

B blocker of CCB

if CCB alone= rate limiting (verapamil/ diltiazem)

29
Q

what to add if stilll Sx after monotherapy for angina

A

a long-acting nitrate
ivabradine
nicorandil
ranolazine

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

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.

32
Q

early diastolic murmur

A

aortic regurgitation

33
Q

pansystolic murmur

A

mitral regurgitation

34
Q

acute cause of aortic regurgitation

A

aortic dissection OR IE

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.’

36
Q

valve problem associated with polycystic kidney disease

A

mitral valve prolapse and mitral regurgitation being the most common

37
Q

ECG normal variants in athlete

A

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

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

39
Q

AF + an acute stroke: when to start DOAC?

A

after 2 weeks
(anti platelet therapy intervening period)

40
Q

when to start DOAC after TIA for AF?

A

straight away

41
Q

clopidogrel common drug ineraction

A

omeprazole

42
Q

statin blood tests

A

LFTs baseline, 3 and 12 months

43
Q

GTN side effects

A

Hypotension + tachycardia + headache

44
Q

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

A

CPAP

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.

46
Q

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

A

if a patient requires a third anti-anginal they should be referred for consideration of a more definitive intervention (PCI or CABG).

47
Q

pregnancy and statin

A

AVOID

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

49
Q

Warfarin management: major bleeding

A

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

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

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

52
Q

warfarin management: INR 5-8 minor bleeding

A

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

53
Q

warfarin management: no bleeding, INR 5-8

A

Withhold 1 or 2 doses of warfarin
Reduce subsequent maintenance dose

54
Q

nicorandil (vasodilatory drum but NOT GTN)) side effects

A

headache
flushing
ANAL ulceration

55
Q

Note the left ventricular hypertrophy and deep ST depression and T-wave inversions consistent with hypertrophic obstructive cardiomyopathy.

A

HOCM

56
Q

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

A

autosomal dominant

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

57
Q

murmur with HOCM

A

mitral regurgitation

58
Q

most common cause of sudden death In HOCM

A

ventricular arrhythmia

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

60
Q

Off driving after CABG?

A

4 weeks

61
Q

off driving after ACS

A

4 weeks - down to 1 week if successful angioplasty

62
Q

U waves

A

Hypokalaemia
hypocalcaemia
hypothermia

63
Q

when is third heart sounds normal?

A

<30 years

64
Q

HOCM what medication to avoid

A

nitrates
ACE-inhibitors
inotropes

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

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

67
Q

what is WPW associated with

A

HOCM
mitral valve prolape
Abstains anomaly
thyrotoxicosis

MSRA (9 decks)

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