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ACC > RRAPID Conditions > Flashcards

RRAPID Conditions Flashcards

1
Q

What is an empyema?

A

Pus in pleural cavity

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2
Q

What are the signs of an empyema?

A

Appears like pleural effusion on CXR

Aspiration of fluid is turbid with pH <7.2, decreased glucose and increased LDH

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3
Q

Which type of drug is specifically used in ICU in septic shock?

A

Inotropes - noradrenaline/Vasopressin

+ all other management

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4
Q

What signs would show a PE on an ECG?

A
  • Large S wave in lead I
  • Q wave in lead III
  • Inverted T wave in lead III
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5
Q

How do you diagnose a DVT?

A

Well’s score > 2 = Doppler/USS
Positive = thrombolyse
Negative - D-Dimer then wait 2 weeks then do again

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6
Q

In what condition would you hear a Gallop Rhythm?

A
  • Pulmonary Oedema
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7
Q

What investigations would you do for Pulmonary Oedema?

A
  • Standard Obs
  • Bloods - ABG, FBC, U+Es, Troponin if chest pain, CRP, BNP - heart failure
  • CXR, ECG, ECHO,
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8
Q

How do you define ACS?

A

Must have at least 2 of the following:

  • Chest pain
  • Increased cardiac markers
  • ECG changes
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9
Q

Give 5 contra-indications of CPAP

A
  • Vomiting
  • Fixed airway obstruction
  • Undrained pneumothorax
  • Patient is unable to protect their own airway (e.g. moribund with low GCS or copious secretions)
  • Patient refusal
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10
Q

when is thrombolysis indicated in STEMI?

A

Streptokinase if within 30minutes of admission

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11
Q

What ECG signs would indicate NSTEMI?

A

ST depression

T wave inversion

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12
Q

What is the management for Low-risk NSTEMI

A

Fondaparinux 2.5mg SC unless coronary angiography is planned within 24hrs of admission, then use unfractionated heparin

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13
Q

How do you differentiate between unstable angina and NSTEMI?

A

NSTEMI has raised cardiac enzymes

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14
Q

What 3 criteria do you look for in stable angina to differentiate between typical or atypical angina?

A
  • Constricting discomfort in chest, neck, shoulders, jaw or arms
  • Precipitation by physical exertion
  • Relieved by rest of GTN within about 5 minutes
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15
Q

How would you manage stable angina?

A

BASIC

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16
Q

What are the vasovagal maneuvres (name 6)?

A
  • Blow through an occluded straw for several seconds
  • Bear down - strain like having a poo
  • Cold water to face
  • Coughing
  • Carotid massage
  • Gagging
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17
Q

What are the symptoms of pericarditis?

A
  • Sudden onset of sharp chest pain that may radiate to the shoulders, neck or back
  • Worse when lying flat or when taking in deep breaths
    Fever, weakness, palpitations, SoB, dry cough
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18
Q

What signs would indicate pericarditis?

A
  • Pericardial friction rub - scratchy sound hears in the midline and lower left sternal border
  • Distension of JVP, muffled heart sounds, low BP
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19
Q

What is Dressler Syndrome?

A
  • Secondary form of pericarditis that occurs due to injury of heart - MI
  • Fever, pleuritic pain, pericarditis, effusion
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20
Q

Which organisms are more likely to cause pericarditis?

A
  • Coxsackie
  • Mumps
  • Herpes
  • HIV
  • TB in developing world - ask about travel
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21
Q

If pericarditis/effusion is suspected, which investigation must be carried out to confirm diagnosis?

A

ECHO

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22
Q

How do you manage pericarditis?

A
  • ABCDE
  • NSAIDS + PPI if using naproxen
  • Steroids if NSAIDs inappropriate - prednisolone
  • Pericardiocentisis if pericardial effusion
  • Consider stopping anticoagulants in case of haemopericardium
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23
Q

What would a sudden onset of excruciating chest pain radiating to the back in a man aged 70 with HTN indicate?

A

Aortic Dissection

24
Q

What gives the definitive diagnosis for aortic dissection?

A

CT angiography

25
Q

What type of rate control medication is contra-indicated in heart failure?

A

Calcium channel blockers

26
Q

What’s the main treatment for Bradycardia?

A

500mcg Atropine, repeat to a maximum of 3mg
Isoprenaline 5mcg/min
Adrenaline 2-10mcg/min

27
Q

What defines 1st degree Heart block?

A

PR interval >5small squares

28
Q

What’s 2nd degree heart block type 1?

A
  • Wenckebach

- PR interval gets longer and longer until QRS is eventually lost

29
Q

What is 2nd degree heart block type 2?

A
  • Every P wave is not followed by QRS
  • Atria may contract twice for every ventricular contrction - 2:1 or 3:1
  • If some P’s don’t get through, you have Mobitz Type 2
30
Q

What is 3rd degree heart block?

A

Atrial activity isn’t conducted to ventricles

31
Q

Give 5 symptoms of heart block?

A
  • SoB
  • Palpitations
  • Light headedness/dizziness
  • Syncope
  • Chest pain
32
Q

How is bradycardia defined?

A

HR < 60bpm

33
Q

What is Wolf-Parkinson-White Syndrome?

A

Presence of an accessory pathway - Bundle of Kent that connects atria and ventricles

34
Q

What would you expect to see on an ECG showing WPW syndrome?

A
  • Short PR interval

- Wide QRS longer than 120ms with a slurred onset producing a delta wave

35
Q

What are the symptoms of WPW?

A
  • Often last a few minutes
  • Starts and stops suddenly
  • Palpitations, dizzy, light-headedness
  • SoB, chest pain, may trigger angina, polyrua
  • COLLAPSE
36
Q

What investigations would you perform for Supra ventricular tachycardia?

A
  • 24hr ECG
  • FBC - anaemia causing tachycardia
  • TFTs - hyperthyroidism
  • Electrolytes
  • Digoxin - toxicity
  • CXR - pneumonia
37
Q

How would you manage haemodynamically unstable SVT?

A
  • Electrical cardioversion - up to 3 times

- Amiodarone 300mg IV and repeat shock followed by amiodarone 900mg over 24hrs

38
Q

How would you manage haemodynamically stable SVT?

A
  • Vagal maneuvres

- IV adenosine 6mg rapid bolus - give further 2 of 12mg

39
Q

What is an alternative medication for haemodynamically stable SVT in an asthmatic?

A
  • Verapamil
40
Q

What medication can prevent SVT?

A
  • Digoxin
  • B-Blocker
  • Verapamil
41
Q

What type of drug overdose increases risk of VT?

A

TCA

42
Q

Which electrolyte abnormalities can cause VT?

A
  • Hyokalaemia
  • Hypomagnesaemia
  • Hypocalcaemia
43
Q

What counts as a narrow QRS complex?

A

<0.12s

44
Q

In a shockable cardiac arrest, when do you give adrenaline?

A

1mg after 2nd shock then after every 2nd cycle

45
Q

In a shockable cardiac arrest, when do you give amiodarone?

A

After 3rd shock

46
Q

In a non-shockable cardiac arrest, when do you give adrenaline?

A

1mg straight away then after every 2nd cycle

47
Q

How do you treat Torsades de pointes?

A

Magnesium

48
Q

What must you do following an anaphylactic shock?

A
  • Update allergy status

- Mast cell tryptase - identifies whether anaphylaxis or not

49
Q

What is DKA?

A
  • Glucose >11
  • Ketones >3
  • pH <7.3
50
Q

How much insulin to you treat DKA with?

A

Fixed rate insulin 0.1units/kg/hr

51
Q

What is the main drug to treat torsades de points?

A

Magnesium IV

52
Q

What can cause seizures?

A
  • Alcohol withdrawal
  • Hypoglycaemia
  • Hypoxia
  • Eclampsia
  • Sodium/calcium abnormalities
53
Q

How would you management Upper GI Bleed?

A
  • IV opioid
  • Terlipressin if suspected varcies
  • H.Pylori test - Carbon-13 urea breath test
54
Q

How do you treat acute pancreatitis?

A
  • ABCDE
  • Analgesia
  • ABx - Cefuroxime
  • Cyclizine
  • Remove gall stones if there
55
Q

What bloods are essential to check in pancreatitis?

A
  • Amylase
  • Lipase
  • FBC, CRP, U+Es, LFTs, Glucose, calcium
56
Q

What INR would you aim for in a patient with paracetamol overdose before withdrawing treatment?

A

< 1.3

57
Q

If a patient is truly allergic to N-acetyl cysteine, what do you give them instead?

A

Methionine

ACC (4 decks)

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