Revision zoom Flashcards
hypertension management under 55 or T2DM
- ACEI or ARB
- add Ca or both ^
- ACEI/ARB + Ca + thiazide
- if K <4.5 = aldosterone antagonist (spironolactone)
if K >4.5 add alpha/beta blocker
treatment of uraemic pericarditis secondary to AKI
haemodialysis
viral pericarditis most commonly caused by
coxsackie virus
clinical presentation of acute pericarditis
chest pain worse lying (relieved leaning) pyrexia dry cough, SOB pericardial rub tachycardia, tachypnoea
management of acute pericarditis
NSAID and colchicine (if viral, idiopathic)
1st degree heart block
prolonged PR >200ms
2nd degree heart block type 1
mobitz/wenckeback
progressive prolongation of PR until a QRS drops
cause of 2nd degree heart block type 1
AV nodal blocking drugs (ca channels, beta blockers, digoxin)
risk factors for infective endocarditis
previous IE prosthetic valves IVDU CHD rheumatic heart disease tattoos/piercing
which valve usually affected in IVDU infective endocarditis?
tricuspid
urinary hydroxyproline suggests
Paget’s disease of the bone
3 causes of HF with reduced ejection fraction
IHD
HTN
DCM
three causes of HF with preserved ejection fraction
HTN, HCM, valvular
high output HF causes
anaemia AV malformations thiamine deficiency thyrotoxicosis Paget's disease of bone pregnancy
diastolic murmur heard at 2nd intercostal space, right sternal edge
aortic regurgitation
key diagnostic investigation for aortic dissection
CT angiography (before sugery IF stable patient)
TOE (if haemodynamically unstable)
causes of aortic dissecition
hypertension trauma Marfan's pregnancy syphilis
murmur commonly heard in aortic dissection
aortic regurgitation
management of aortic dissection
Stanford A - emergency: IV beta blockers (labetolol) and surgery
Stanford B - conservative management
murmurs heard with VSD
pansystolic murmurs cannot be extenuated by changes in breathing or manoeuvres
Post MI complications
Dressler's arrest (VF) Regurgitation mitral (due to ischaemia/papillary muscle rupture. pansystolic murmur LOUDER on expiration and radiates to axilla) T Heart failure (usually systolic) VSD (rupture of IV septum, with acute HR, pansystolic murmur with no changes with breathing) Acute pericarditis D E r
pansystolic murmur louder on expiration and radiates to axilla
mitral regurgitation
first line COPD
SABA/SAMA
alveolar transfer factor for COPD patient
decreased due to dysfunctional type 1 pneumocytes that form up alveoli and hence reduced exchange in COPD
COPD symptoms in young person non smoker?
alpha anti-trypsin deficiency
three complications of COPD
secondary polycythaemia (dec O2 -> inc demand for RBC)
pulmonary hypertension (backing up pressure in systemic. -> cor pulmonale)
peripheral oedema
pharmacological management of PE
apixaban/riveroxaban/dabigatran
unprovoked = 6 m
provoked = 3m
cancer = 3-6m
what does squamous cell cancer produce (lung)
PTHrp –> acts like hypercalcaemia.
what imaging feature separates MS from other neurological conditions
disseminated in space and time
presence of oligoclonal bands in CSF
Guillain-Barre syndrome commonly caused by what organism
campylobacter jejuni
- antibodies produced by bacteria are similar to antigens on Schwann cells on peripheral nerves
clinical features of Guillain barre syndrome
progressive symmetrical ascending weakness reflexes reduced or absent flaccid paralysis leg and back pain after eating bad meal
investigations for Guillain Barre syndrome
LP (inc protein with normal WBC)
Nerve conduction studies = slow
FVC - weakening of muscles
treatment options for Guillain Barre syndrome
IV Imunoglobulins
Plasma exchange (take bad ones out)
ITU ventilation
clinical features of myasthenia gravis
- extraoculr muscle weakness (diplopia)
- proximal muscle weakness: face, neck, limb girdle
- ptosis
- dysphagia
Investigations for myasthenia gravis
CT thorax to exclude thymoma
Single fibre electromyography!!
CK must be normal
Management for myasthenia gravis
- long term
- long acting acetylcholinesterase inhibitors (pyridostigmine)
- immunosuppression (prednisolone)
- thymectomy