SBA exam Flashcards
What is the treatment for croup?
Self limiting BUT dexamethasone can help
Emergency management –> nebulised adrenaline
What is the treatment for whooping cough?
Macroglides:
azithromycin, clarithromycin etc
What causes pulmonary hypertension?
1) Vasoconstriction in the lungs secondary to hypoxia from certain conditions (COPD, pulmonary fibrosis)
2) Left sided ventricular disease causing venous congestion (eg. mitral valve disease) –> back up into the pulmonary vessels
3) Idiopathic
4) Embolic disease (PE)
What are the signs of pulmonary hypertension?
SOB, fatigue, chest pain, peripheral odema, recurrent fainting/dizziness
Right heart enlargement (due to trying to pump against increased pressure) –> increase force
Right heart strain
–> right axis deviation, tall P waves
Treatment for pulmonary hypertension?
Prostaglandins
How does hypertrophic cardiomyopathy show on ECG?
VENTRICULAR hypertrophy –> large QRS
What does the murmur from PDA sound like?
What is this condition associated with?
Continuous machinery
Associated with prematurity
What does the murmur from ASD sound like? Why?
Crescendo-decreshendo
Fixed split second heart sound due to the pulmonary and the aortic valves closing at different times (more blood is in the right side of the heart compared to the left –> more blood needs to empty before can close)
What are the complications of ASD?
What other conditions does this occur with?
L –> R shunt
Increasing pulmonary pressures
Pulmonary hypertension
R side of heart is then increased pressure compared to L side (can cause RSHF due to cardiomyopathy)
R –> L shunt
Bypasses the lungs, none oxygenated blood then entering the circulation
Cyanotic (EISENMENGER SYNDROME)
Also occurs with:
VSD
PDA
How can ASD allow a stroke to occur?
In patients with DVT - clot goes to L side of the heart - would NORMALLY go to lungs and cause PE
BUT with ASD –> passes through the septum to L side of the heart –> able to go into the circulation up to the brain
How do children with heart problems normally present?
Poor feeding
Failure to thrive
Dyspnoea
Tachypnoea
What are the possible causes of a pan systolic murmur?
Mitral valve regurg
Tricuspid regurg
Ventricular septal defect
What is the sound of the following murmurs:
1) ASD
2) VSD
3) PDS
1) Cresh-decresh mid systolic
2) Pan systolic
3) Machinery
Examination findings of eisenmengers syndrome and why?
Increased JVP and peripheral oedema - due to increased pulmonary hypertension (1st stage)
Cyanosis and clubbing due to deoxygenated blood escaping into peripheral circulation (2nd stage)
Right ventricular heave (increased size due to trying to pump against increased pressure)
Loud S2 - forceful shut of pulmonary valve due to increased pressure
What is the tetralogy of fallot?
What are the consequences?
1) Rightward displacement of the aorta (overriding aorta)
2) VSD
3) Pulmonary stenosis
4) Right sided hypertrophy
–> cyanosis
–> Tet spells
What does the complications of coarctation of the aorta depend on?
How to manage in the short term?
Where the coarctation is - if it is before the ductus arteriosis or after as the ductus arteriosis after the coarctation can give oxygenated blood straight into aorta
Prostaglandins keep the duct open until surgery can occur
What is the most comon cause of cardiac sudden death in teenagers?
Hypertrophic cardiomyopathy
What is hypertrophic cardiomyopathy?
What does this cause?
AUTOSOMAL DOMINANT CONDITION that causes thickening of the muscle in the LEFT ventricle due to abnormal genes in the heart chamber - especially the septum
Obstruction of the left ventricular outflow tract due to the septum blocking the outflow tract
Reduced volume of the left ventricle
–> arrythmias
–> sudden death (esp in athletes)
What is rhuematic fever?
How does it present
Autoimmune Inflammatory disease common in developing countries
Developing 2-4 weeks after strep infection
Presents with sore throat, swelling/pain in multiple joints, valve damage –> rheumatic heart disease
Joint pain
O cardits
Nodules on hands/wrists
Erythema marginatum (none itchy rash)
Sydenhams chorea - involuntary, jerky muscles
How to distinguish between the different types of cardiomyopathy
Dilated - normally a cause (eg. alcoholsim, hypertension, myocarditis). Large heart on CXR
Restrictive - infiltrative process cause (eg. radiotherapy, chemotherapy, amylodosis, fibrosis etc) normal heart size, EF normal
What is marfans syndrome?
What do these people look like?
What does this cause?
Connective tissue disorder
Tall, thin, long arms, long neck, long fingers, chest deformity, high arch palate, hypermobile
Mitral valve prolapse - mid systolic click with late systolic murmur
What are the complications of marfans syndrome?
joint discolorisation
scolliosis
GORD
aortic anurysm
mitral valve prolapse
aortic valve prolapse
What is cystic fibrosis?
How does it present?
How to dignose
Autosomal RECESSIVE disorder causing low salt and chloride into airways –> increased viscosity of secretions due to less attraction of water to the ions
1) Recurrent chest infections
2) Malabsorption due to thick secretions in the pancrease –> digestive enzymes cannot get to the small intestine –>fat not absorbed –> faliure to thrive, greasy stools
3) Salty skin
4) Meconium ileus
5) Pancreas –> diabetes , pancreatitis
Heel prick
Sweat test is older
what is characteristic of XR in TB?
Lung nodules/scaring/granulomas/cavitation
coughing up blood
What are signs of military TB and why?
- WBC in urine
- Meningitis
- Potts
- Addisons
- Hepatitis
- Lymphandentitis
Granulomas spread through the vascular system –> infecting the body
What is the treatment for TB?
Rifampin
Izoniazid
Pyrazinamide
Ethambutol
What is bronchiectasis?
what is its associations?
abnormal dilatation of bronchi du to chronic inflammation of the lungs
Chronic cough, airflow obstruction, chronic sputum production
what causes bronchiectasis?
pot infections, immunodeficiency, connective tissue diseases, toxic insults, congenital defects (CF)
what is the test for TB?
acid-fast bacilli smear
What is sarcoidosis?
chronic granuloatous disorder
What are the similarities between TB and sarcodosis?
What is the difference between sarcoidosis and TB?
Both are granulomatous diseases with lung and extra pulmonary manifestations
Sarcoidosis –> non-caseating granulomas (non-necrotic centre, caused by inflammatory condition)
TB –> caseating granuloms (necrotic centre, caused by infection)
What are the CXR signs of sarcoidosis?
Hilar adenopathy (enlargement of lymph nodes)
diagnosis of sarcoidosis?
Treatment?
biopsy of granulomas
steroids
Symptoms of sarcoidosis?
Erythema nodosum - red swollen fat under the skin
arthritis/polyarthralgia
hilar adenopathy
fever
What blood markers are raised in sarcoidosis? WHY?
ACEi - non specific
Calcium - due to increased circulation of vit D produced by macrophages - increases absorption of calcium from the gut
What is dresslers syndrome
pericarditis that occurs 2-3 weeks post MI
What antibodies are tested for polymyalgia rheumatica?
ANA
What antibodies are tested for CREST syndrome?
Anti-ceremore
What should you rule out with bilateral shoulder pain?
Polymyalgia rheumatica
What is crest synfrome?
Calcinosis
Raynauds phenomenon
Esophageal dysfunction
Sclerodactylayl - bent fingers
telangiectasis - dilation of the capillaries of the skin
What confirms the diagnosis of polymyaglia rheumatica?
rapid response to oral corticosteroids
What is the score for high risk of fragility fracture?
-2.5
What diabetic drugs are best for cardioprotection?
SGLT-2 inhibitors (gliflozin)
What drugs are SU examples?
When not to use?
glipizide
-ides
In drivers etc –> cause hypoglycemic episodes
What drugs are not good to use to control diabeties in high BMI patients?
SU and proglitazone
What are side effects of proglitazone?
-URE
heart faliure
bladdure cancer
fracture
