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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
What type of rate control medication is contra-indicated in heart failure?
Calcium channel blockers
26
What's the main treatment for Bradycardia?
500mcg Atropine, repeat to a maximum of 3mg Isoprenaline 5mcg/min Adrenaline 2-10mcg/min
27
What defines 1st degree Heart block?
PR interval >5small squares
28
What's 2nd degree heart block type 1?
- Wenckebach | - PR interval gets longer and longer until QRS is eventually lost
29
What is 2nd degree heart block type 2?
- 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
What is 3rd degree heart block?
Atrial activity isn't conducted to ventricles
31
Give 5 symptoms of heart block?
- SoB - Palpitations - Light headedness/dizziness - Syncope - Chest pain
32
How is bradycardia defined?
HR < 60bpm
33
What is Wolf-Parkinson-White Syndrome?
Presence of an accessory pathway - Bundle of Kent that connects atria and ventricles
34
What would you expect to see on an ECG showing WPW syndrome?
- Short PR interval | - Wide QRS longer than 120ms with a slurred onset producing a delta wave
35
What are the symptoms of WPW?
- Often last a few minutes - Starts and stops suddenly - Palpitations, dizzy, light-headedness - SoB, chest pain, may trigger angina, polyrua - COLLAPSE
36
What investigations would you perform for Supra ventricular tachycardia?
- 24hr ECG - FBC - anaemia causing tachycardia - TFTs - hyperthyroidism - Electrolytes - Digoxin - toxicity - CXR - pneumonia
37
How would you manage haemodynamically unstable SVT?
- Electrical cardioversion - up to 3 times | - Amiodarone 300mg IV and repeat shock followed by amiodarone 900mg over 24hrs
38
How would you manage haemodynamically stable SVT?
- Vagal maneuvres | - IV adenosine 6mg rapid bolus - give further 2 of 12mg
39
What is an alternative medication for haemodynamically stable SVT in an asthmatic?
- Verapamil
40
What medication can prevent SVT?
- Digoxin - B-Blocker - Verapamil
41
What type of drug overdose increases risk of VT?
TCA
42
Which electrolyte abnormalities can cause VT?
- Hyokalaemia - Hypomagnesaemia - Hypocalcaemia
43
What counts as a narrow QRS complex?
<0.12s
44
In a shockable cardiac arrest, when do you give adrenaline?
1mg after 2nd shock then after every 2nd cycle
45
In a shockable cardiac arrest, when do you give amiodarone?
After 3rd shock
46
In a non-shockable cardiac arrest, when do you give adrenaline?
1mg straight away then after every 2nd cycle
47
How do you treat Torsades de pointes?
Magnesium
48
What must you do following an anaphylactic shock?
- Update allergy status | - Mast cell tryptase - identifies whether anaphylaxis or not
49
What is DKA?
- Glucose >11 - Ketones >3 - pH <7.3
50
How much insulin to you treat DKA with?
Fixed rate insulin 0.1units/kg/hr
51
What is the main drug to treat torsades de points?
Magnesium IV
52
What can cause seizures?
- Alcohol withdrawal - Hypoglycaemia - Hypoxia - Eclampsia - Sodium/calcium abnormalities
53
How would you management Upper GI Bleed?
- IV opioid - Terlipressin if suspected varcies - H.Pylori test - Carbon-13 urea breath test
54
How do you treat acute pancreatitis?
- ABCDE - Analgesia - ABx - Cefuroxime - Cyclizine - Remove gall stones if there
55
What bloods are essential to check in pancreatitis?
- Amylase - Lipase - FBC, CRP, U+Es, LFTs, Glucose, calcium
56
What INR would you aim for in a patient with paracetamol overdose before withdrawing treatment?
< 1.3
57
If a patient is truly allergic to N-acetyl cysteine, what do you give them instead?
Methionine

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