Supporting Life Flashcards
What is pleuritic chest pain?
Sudden sharp chest pain when inhaling or exhaling
What is normal JVP?
3cm vertical height above the sternal angle
Give 3 symptoms of aortic stenosis
Dyspnoea
Chest pain (angina)
Syncope
Give three features of the murmur in aortic stenosis
Ejection/midsystolic
Radiates to neck
Located over aortic listening point
What ECG features are characteristic of type 2 heart block, Mobitz 1?
Progressively elongating PR interval until one P wave fails to conduct and then it resets
What ECG features are characteritic of Mobitz 2 heart block
Randomly skipped QRSs without being preceeded by progressive PR elongation
What is first degree heart block?
Elongation of PR interval to greater than 0.22 seconds
Give two products of GTN metabolism and their functions
NO - vasodilator
Superoxide (O free radical) - inhibits guanylate cyclase, inhibiting vasodilation - affects arteries more than veins - contributes to tolerance
What common angina drug is contraindicated in vasospastic angina?
Beta blockers (sympathetic stimulation helps dilate coronaries)
Give two calcium channel blockers
Verapamil
Amlodipine
What is Nicorandil and what does it do? (Mechanism of action)
Katp channel activator. Stimulates K efflux hyperpolarising smooth muscle.
Also stimulates guanylate cyclase
Vasodilator to lower TPR in angina
What does ranolazine do?
Reduces cardiac stiffness in angina
What does ivabradine do and what is it’s mechanism of action?
Reduces HR
Inhibits funny current
What is the main 2 ECG finding in ventricular tachycardia?
Broad QRS (>0.14) P wave dissociation (tachycardia though, unlike third degree block)
What three drugs classes do you use to treat ventricular tachycardia?
Classes 1,2,3 - Na blockers - beta blockers - K blockers (Respectively)
Give 3 spirometery findings of restrictive lung disease
Reduces lung volume (forced vital capacity)
FEV1 not reduced
FEV1/FVC normal or increased
Give two causes of diffuse pleural thickening
TB
Asbestos
What two antifibrotics are used to manage Ideopathic Pulmonary Fibrosis?
Pirfenidone
Nintedanib
What is ketamines mechanism of action?
NMDA antagonist
What is benzodiazepines mechanism of action?
GABA agonist
Give 6 prerenal causes of AKI
Hypotension Sepsis Hepatorenal syndrome Heart failure Renal artery occlusion Vasculitis
Give three common intrinsic causes of AKI (and their causes)
Acute tubular necrosis (hypovoleamia or drugs) Rapidly progressing glomerulonephritis (autoimmune eg lupus) Interstitial nephritis (infection or drugs eg penicillin)
Give three post renal causes of AKI
Kidney stone
Tumor
Reteriperitoneal fibrosis
What ECG shape is found in v high hyperkalaemia (>8.0mmol/l)
Sine wave
What acid base imbalance does AKI cause?
Metabolic acidosis
What are daily maintainence requirements of fluid, sodium, potassium and chloride?
Fluid 25-30ml/kg/day
Salts 1mmol/kg/day each
Give 6 signs of hypovoleamia
Fast weak pulse Postural drop of >20mmhg Low BP Loss of skin turgor Sunken eyes Dry mucus membranes
Give 5 signs of hypervolemia
Fast, bounding pulse High BP (but may be low!) Periferal odema High JVP Ascites
Give three fluids used for resusitiation
Balanced crystalloids (Hartmann)
NaCl (Saline)
Colloids
Give two fluids used for maintainence
5% glucose
5% glucose w saline
Give three symptoms of moderate hyponatreamia (121-129)
Cramps
Weakness
Nausea
Give 3 symptoms of severe hyponatreamia (<120)
Lethargy
Headaches
Confusion
Give three symptoms of severe and rapidly evolving hyponatreamia <120
Seizures
Coma
resp arrest
Give 4 causes of euvoleamic hyponatreamia
Water intoxication
Hypothyroid
Hypopituatary
SIADH (eg from small cell lung cancer)
What are daily maintainence requirements of fluid, sodium, potassium and chloride?
Fluid 25-30ml/kg/day
Salts 1mmol/kg/day each
Give 6 signs of hypovoleamia
Fast weak pulse Postural drop of >20mmhg Low BP Loss of skin turgor Sunken eyes Dry mucus membranes
Give 5 signs of hypervolemia
Fast, bounding pulse High BP (but may be low!) Periferal odema High JVP Ascites
Give three fluids used for resusitiation
Balanced crystalloids (Hartmann)
NaCl (Saline)
Colloids
Give two fluids used for maintainence
5% glucose
5% glucose w saline
Give three symptoms of moderate hyponatreamia (121-129)
Cramps
Weakness
Nausea
Give 3 symptoms of severe hyponatreamia (<120)
Lethargy
Headaches
Confusion
Give three symptoms of severe and rapidly evolving hyponatreamia <120
Seizures
Coma
resp arrest
Give 4 causes of euvoleamic hyponatreamia
Water intoxication
Hypothyroid
Hypopituatary
SIADH (eg from small cell lung cancer)
Give three non renal (urine na <25mmol/l) hyponatreamia
Hypervolemic
Congestive heart failiure
Cirrhosis
Nephrotic syndrome
Give a renal (urine na >30 mmol/l) cause of hyponatreamia
Hypervoleamic
CKD (kidneys fail to excrete water but not na)
Give three non renal (urine na<25) of hyponatreamia
Hypovoleamic
GI loss
Dermal loss (sweat)
3rd spacing of fluids
What is the management for hypovoleamic hyponatreamia?
0.9% IV saline
What is management for euvoleamic or hypervoleamic hyponatreamia?
Treat underlying cause
Fluid restriction
Give two causes of hypernatreamua due to sodium overload
Administration of high salt load by IV fluids
Hyperaldosteronism (conns disease = primary hyperaldosteroneism)
What’s the management for hypernatreamia?
Give hypotonic fluid eg 5% dextrose slowly to dilute it
Give 3 symptoms of hyperkaleamia
Muscle weakness/paralysis
paraestheasia
Arrhythmia
Give 3 treatments for hyperkaleamia
Insulin + glc (insulin drives potassium into cells) IV calcium (antagonises K effect of cardiac membranes) Remove K+ via loop diuretics or heamodyalysis
give 4 causes of hypokaleamia
reduced intake
Entry into cells due to alkalosis
GI/urine/sweat loss
Hyperaldosteronism
give 4 clincal manifestations of hypokaleamia
Muscle weakness
ECG changes
Renal abnormalities
rhabdomyelisis
Give 3 ECG features typical of hypokaleamia
U wave
ST depression
flat T wave
long QT
PR elongation
(U DEPRESSED Fam)
give 4 causes of high anion gap metabolic acidosis
ketoacidosis
lactate acidosis
renal failiure!! (eg. in AKI)
Toxins eg. asprin
Give 3 causes of normal anion gap metabolic acidosis
Diahorrea
Surgical drains
Renal tubular acidosis
All due to loss of Hco3 without gain of other unmeasureable anions
Is COPD eaosinophilic or non?
non eosinophilic
Give 3 main symptoms of COPD
Sputum
Wheeze
Dyspnea
What is Cor pulmonal?
Enlargement of R heart due to lung disease (occurs in COPD)
Due to reflexive vasoconstriction due to low pO2 in lungs
Give 5 lung number changes in COPD
inc resp rate inc FRC inc residual volume dec inspiratory capacity dec inspiratory reserve volume
Give 5 airway changes in COPD
Chronic Bronchitis Emphysema Cillia destuction increased goblet cells Bronchial submucosal gland hyperplasia/dysplasia
Give 3 inflammatory cells in COPD
Neutrophil
CD8
fibroblast
(Not Eosinophil!)
what is the most common microorganism causing pneumonia?
Strep. Pneumoniea
give 5 factors that score a point in the CURB65 scoreing system for pneumonia?
confusion serum urea >7mmol Resp rate >30 BP below 90 systolic or 60 diastolic aged 65 or older
Give 4 common causes of community aquired pneumonia
strep pneumonia
Viral (influenza a/b)
Staph Aureus
Heamophilus influenzae
What Abx should be added if a pateint for pneumonia has risk factors for MRSA
Vancomycin
What pathogen causes legionaires disease?
Legionella pneumophillia
What is non pneumonia legionella infection called?
Pontiac fever
What is typical history exposure suggesting legionaires?
Water exposure
in addition to pneumonia symptoms, what are the 2 classic signs of legionaires?
prominent headache
fever w/o tachycardia
What Abx class should you use for legionaires disease? 2 available
fluroquinolone (eg. levofloxacin)
Macrolide (eg. axithromycin)
give 2 common organisms causing atypical pneumonia
Mycoplasma pneumoniae
Chlamydophila pneumoniae
give a typical symptom of atypical pneumonia
hoarseness
What demographic does atypical pneumonia typically affect?
young adults living in close proximity
What antibiotic should be used for athypical pnemonia?
Macrolides (eg. azithromycin)
- standard pneumonia treatment includes this for coverage as penicillin wont work on these
Give two common organisms causes hospital aquired pneumonia
Psudomonus Aeruginosa
E. Coli
Give 4 causes of immunocompromise causing increased pneumonia susectibility
neutrophil defect (chemo therapy) Abx defect (primary immune deficiency) T cell defect (HIV) High does steroid (eg for rheumatoid artheritits)
What is the antifungal of choice for aspergillus infection of lungs?
Voriconazole
Give three causes of pneumonia specific to immunocompromised patients
Aspergillus
Nocardia
Pneumocystis jiroveci
What is the CT finding in Aspergilllus infection
‘halo sign’ - circle like structures in lungs
What type of immunocompromise is typically seen in patients with nocardia
T cell eg. HIV, high dose steroids, post transplant
what abx do you use to treat nocardiosis and pneumocystis jirovecci?
septrin (a combination)
is asthma, what does IL-13 do?
Mucus hypersecreation
In asthma, what does IL-5 do?
Attacts and degranulates eosinophils
Give four signs of infective endocarditis
Fever
Murmurs
Vegetations on echo (lesions)
Positive blood cultures (commonly staph aureus)
What two types of hypersensitivity is asthma?
type 1 and type 4
give two actions of histamine released from mast cells in asthma
Vasodilation (causes mucosal odeama)
Bronchoconstriction
Give two actions of tryptase is asthma
remodels tissue
mucus hypersecreation
give two functions of the de novo produced prostaglandin (PGD2) in asthma
vasodilation
bronchoconstriction
Give one function of leukotrienes de novo produced by mast cells in asthma
bronchoconstriction
give four outcomes of the tissue remodeling in asthma due to tryptase
epithelial cell damage causing odema
BM thickening
Airway SM thickening
Mucusgland hypertrophy
What is the normal function of eaosinophils
killing of extracellular parasites
what two classes of bronchodilators are used in asthma
B2 agonists
anticholinergics/antimuscarinics
give three long acting beta 2 agonists used in asthma
vilanterol
salmetorol
formoterol
give 2 anticholinergics used in asthma bronchodilation
ipratropium
tiotropium
give one inhaled corticosteroid used in asthma
Fluticasone
what class of drugs can be used instead of ICS (inhaled corticosteroids) i asthma for children
Leukotriene Receptor Antagonists (LTRA)
eg. Nedocromil
What three types of hepatitis virus are likely to cause chronic infection
B,C,D
what type of drug is bendroflumethiazine?
thiazide diuretic
Give two potassium sparing diuretics
amiloride
spirolactone
Give 5 drug classes to give in urgent/severe asthma exacerbation
SABA Anticholinergic (ipatropium bromide) O2 Corticosteroid (Oral or IV) - Prednisolone IV magnesium
How long should one canister of inhaled corticosteroid last for a asthma patient?
1 month
What organism most likely causes infective endocarditis from dental procedures?
Strep. Viridans
What organism is the most common cause of infective endocarditis? Esp in IVDU
Staph aureus
Give four drugs/ classes that can causes SIADH
Sulphonylurea
SSRI
Tricyclic antidepressants
Carbamazapine
What is the maximum safe rate to raises sodium in hyponatreamia
8mmol/d
What does raising serum sodium too quickly put pt at risk of?
Central pontine myelinolysis
What is the most common lower resp tract infection in <1 yros and what is the causative organism?
Bronchiolitis
Resp. syncytial virus
Give four pharmocodynamic effects of propofol
Apnoea (30s to 30min)
Decreased CO and TRP (therefore decreaed BP)
decrased ICP (allows for normal CPP with the lower BP)
antiemetic
Give three barbiturates
Thiopental
Methoxital
Phenobarbital
Give four pharmocodynamic effects of barbiturates
and what system is it protective of?
Apnoea
Decreased CO (periferal vasodilation and -ve ionotropy)
decreased ICP and cerebral o2 demand
seizure supression
Overll, good neuroprotective eg. good for head trauma
give three pharmacodynamic effects of benzodiazepines
and what system are they protective of?
No apnoea (but decreased upper airway tone)
Only v small BP drop
anticonvulsant
Anxiolysis (reduces anxiety)
V cardioprotective - heamodynamically stable
Give a benzodiazepine antagonist
Flumezanil
Give three pharmacodynamic effects of ketamine and on what patients is it good to use of?
No apnoea
Increased BP, HR, CO
Increased ICP, cerebral metabolic O2 demand
Good for heamodynamically unstable Pts
Give three pharmacodynamic actions of etomidate and for what patients is it good for?
transient hyperventiation followed by apnoea
raised BP
decreased ICP
Good fro heamodymically unstable Pts
Give two pharmacodynamic effects of dexmedetomidine and what patients is it good for?
No apnoea or resp depression decreased CO (bradycardia)
Good for awake craniotomy
Give 6 pharmacodynamic effects of morphine
huge resp suppresion cardio stable sedation/euphoria constipation pruritis Biliary constriction
Give the 4 main opioids in order of potency
Fentanyl
Morphine
Codine
Tramadol
Which opioid has the shortest action (cotext sensitive half life)
Remifentanyl
Which two induction agents raised the CO/BP so are good for heamodynamically unstable Pts?
Ketamine
Etomidate
Which two induction agents casue apnoea, decreased BP and decreased ICP?
Propofol
Barbiturates
Give two cardiac complications of bicuspid aortic valve
Aortic stenosis
Aortic regurgitation
Give two disgnostic findings suggestive of mitral stenosis
(late) Diastolic murmur
May have irregularly irregular heartbea - like AF
Give four cardiovascular complications which may occur in Marfans
Aortic dissection
Aortic Aneurysm
Aortic regurgitation
Mitral Prolapse
Apart from height, give two feature of sppearence of Marfans
High Arched Palette
Scoliosis
What arrhythmia is an indication for a permanant pacemaker?
3rd degree heart block
Give two ECG findings of NSTEMI
T wave inversion
ST depression
Rheumatic fever is a complication of what infection?
Streptococcal pharyngitis
Wha vavular defect is a common complication of rheumatic fever?
Mitral Stenosis
Give 2 ECG features of pericarditis
PR depression
Saddle Shaped ST elevation
Give four causes of pericarditis?
Viral infection
Dressler’s syndrome - post MI
TB
ureamia
Give three signs/symptoms of Pericarditis
Peuritic chest pain (stabbing, worse on inspiration)
Alleviated by sitting forward
Pericardial rub
What is S3 heart sound usually a sign of?
systolic heartfailiure but may be normal eg in pregnancy or atheletes (increased complience)
What is S4 heart sound usuallya sign of?
Diastolic heart faililure- hypertrophy. Also may be due to active ischeamia (caused by decreased complience)
When does a physiological spilt of S2 happen?
Inspiration
What does a fixed spil of S2 suggest
Atrial septal defect
What does a paradoxical split of S2 suggest?
Aortic stenosis
Left bundle branch block
(any condition resulting in a delay in Aortic closure)
What does a widened S2 split suggest?
RBBB
Mitral regurg
(any condition that casues a delay to pulmonary closure or early aortic closure)
What does a mid systolic click suggest
Mitral prolapse
How do you treat AKI caused by acute interstitial nephritis
steroids
Give 2 formulea used to estimate GFR from serum creatinine and which is better?
MDRD (better and more commonly used)
Cockroft and Gault
Why would you give Epo injections in CKD
For renal aneamia (Epo is the activated for of erythropoetin)
What is IgA nephropathy and give 4 symptoms of it
IgA deposition in kidneys causing glomerularnephritis Microscopic heamaturia HTN Proteinurea Progressive renal impairment (Ix with serum IgA)
What genetic condition causes glomerulonephritis (with universal heamaturia) and hearing loss
Alports disease
Give 2 macrolides
Azithomycin
Erythromycin
Give the class of and an example of the Abx used in serious sepsis
Gentamycin
class is aminoglycosides
give two glycopeptides and are they better against gram +ve or -ve?
Vancomycin (used against MRSA)
Teicoplanin
only work aginst +ve
Give two Quinolones (flouroqinolones) and state is theyre better against gram +ve or -ve
Levoflouracin
Ciproflouracin
Better agianst -ve (used in legionaires)
Give 7 signs of tension pneumothorax
Resp distress tachycardia hypotension distended neck veins increased resonance decreased breath sounds trachea devated away
Give two features that may suggest tension over normal pneumothorax
Trachea deviated away
distended neck veins
What is Becks triad for Cardiac tamponarde
Raised JVP
Falling BP
Muffled Heart Sounds
what would tousarde de pointsshow on ECG?
Rapid, irregular QRS that twist around the baseline
What ECG abnormality is Tousarde de points associated with?
Long QT
Give 7 post MI complications
VT Pericarditis papillary muscle dysfunction mural thrombosis ventricular rupture -> tamponarde ventricular anurysm dressler syndrome
What 2 examination findings are typical in restrictive lung disease
Clubbing and crackles
How do you differentiate ideopathic pulmonary fibrosis and non-specific interstital pneumonia (3 things)
Non specific interstitial pneumonia is autoimmune associated (eg lupus), has ground glass opacities in CT and has no honeycombing
What happens in sarcoidosis
non ceasating granulomatous inflammation affecting the lungs, eyes and skin (may produce a interstitial lung disease)
are left sided murmurs louder on inspiration or expiration and vice versa?
Left sided = louder on expiration
right sided = louder on inspiration
Give 2 blood changes that may occur in shock?
increased neutrophils
decreased coagulation time
give the four stages of shock classfication (according to %blood lost)
1 = 0 -15% 2 = 15-30% 3 = 30-40% 4 = >40%
Give three treatments for Delayed sleep phase disorder?
Phototherapy
Low dose melatonin
CBT
How is shift work disorder diagnosed?
Insomnia/ excessive daytime sleepiness for over 1 month
Diagnosis of exclusion
During which halves of the night do NREM and REM parasomnias happen (respectively)
NREM = 1st half REM = 2nd half
What is the overall cause of concentric hypertrophy and give 2 specific causes of this?
Give the basic process of concentric hypertrophy
Pressure overload
HTN, Aortic stenosis
Wall bulks up, radius decreases, whole thing dilates
What is the overall cause of dilated cardiomyopathy and give 1 specific causes of this?
Give the basic process of dilated cardiomyopathy
Volume overload
Aortic regurgitation
wall bulks up, radius also increases
Give 3 reasons why COPD presents with breathlessness
expiratory flow rate cant increasd much
Needs dynamic hyperinflation to increase expiratory flow which requires lungs to work at level with lower complience
functional diaphragm weakness (as its already flattened)
Which is eosinophilic, COPD or asthma?
Asthma
give 3 KDIGO definition of AKI
raise of serum creatinine of >26.5 (88-150) in 48 hr OR 1.5x raise in serum creatinine in 7 days OR <0.5ml/kg/hr of urine output for 6 hours
Give 3 consequences of retention of metabolic waste product in AKI?
Encephalitis
Pericarditis (may progress to tamponarde)
pleurisy
What is the overall process that causes type 1 resp failiure?
VQ mismatch (eg. pulmonary odema, PE, pneumothorax)
What is the overall process that causes type 2 resp failiure?
Disruption of the ventilatory apparatus (eg. stoke, fail segment ect.)
