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Supporting Life > Supporting Life > Flashcards

Supporting Life Flashcards

1
Q

What is pleuritic chest pain?

A

Sudden sharp chest pain when inhaling or exhaling

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2
Q

What is normal JVP?

A

3cm vertical height above the sternal angle

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3
Q

Give 3 symptoms of aortic stenosis

A

Dyspnoea
Chest pain (angina)
Syncope

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4
Q

Give three features of the murmur in aortic stenosis

A

Ejection/midsystolic
Radiates to neck
Located over aortic listening point

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5
Q

What ECG features are characteristic of type 2 heart block, Mobitz 1?

A

Progressively elongating PR interval until one P wave fails to conduct and then it resets

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6
Q

What ECG features are characteritic of Mobitz 2 heart block

A

Randomly skipped QRSs without being preceeded by progressive PR elongation

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7
Q

What is first degree heart block?

A

Elongation of PR interval to greater than 0.22 seconds

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8
Q

Give two products of GTN metabolism and their functions

A

NO - vasodilator
Superoxide (O free radical) - inhibits guanylate cyclase, inhibiting vasodilation - affects arteries more than veins - contributes to tolerance

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9
Q

What common angina drug is contraindicated in vasospastic angina?

A

Beta blockers (sympathetic stimulation helps dilate coronaries)

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10
Q

Give two calcium channel blockers

A

Verapamil

Amlodipine

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11
Q

What is Nicorandil and what does it do? (Mechanism of action)

A

Katp channel activator. Stimulates K efflux hyperpolarising smooth muscle.
Also stimulates guanylate cyclase

Vasodilator to lower TPR in angina

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12
Q

What does ranolazine do?

A

Reduces cardiac stiffness in angina

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13
Q

What does ivabradine do and what is it’s mechanism of action?

A

Reduces HR

Inhibits funny current

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14
Q

What is the main 2 ECG finding in ventricular tachycardia?

A 
Broad QRS (>0.14)
P wave dissociation (tachycardia though, unlike third degree block)
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15
Q

What three drugs classes do you use to treat ventricular tachycardia?

A 
Classes 1,2,3
- Na blockers 
- beta blockers
- K blockers 
(Respectively)
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16
Q

Give 3 spirometery findings of restrictive lung disease

A

Reduces lung volume (forced vital capacity)
FEV1 not reduced
FEV1/FVC normal or increased

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17
Q

Give two causes of diffuse pleural thickening

A

TB

Asbestos

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18
Q

What two antifibrotics are used to manage Ideopathic Pulmonary Fibrosis?

A

Pirfenidone

Nintedanib

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19
Q

What is ketamines mechanism of action?

A

NMDA antagonist

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20
Q

What is benzodiazepines mechanism of action?

A

GABA agonist

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21
Q

Give 6 prerenal causes of AKI

A 
Hypotension
Sepsis
Hepatorenal syndrome
Heart failure 
Renal artery occlusion 
Vasculitis
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22
Q

Give three common intrinsic causes of AKI (and their causes)

A 
Acute tubular necrosis (hypovoleamia or drugs)
Rapidly progressing glomerulonephritis (autoimmune eg lupus)
Interstitial nephritis (infection or drugs eg penicillin)
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23
Q

Give three post renal causes of AKI

A

Kidney stone
Tumor
Reteriperitoneal fibrosis

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24
Q

What ECG shape is found in v high hyperkalaemia (>8.0mmol/l)

A

Sine wave

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25
Q

What acid base imbalance does AKI cause?

A

Metabolic acidosis

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26
Q

What are daily maintainence requirements of fluid, sodium, potassium and chloride?

A

Fluid 25-30ml/kg/day

Salts 1mmol/kg/day each

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27
Q

Give 6 signs of hypovoleamia

A 
Fast weak pulse
Postural drop of >20mmhg 
Low BP
Loss of skin turgor
Sunken eyes
Dry mucus membranes
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28
Q

Give 5 signs of hypervolemia

A 
Fast, bounding pulse
High BP (but may be low!)
Periferal odema
High JVP
Ascites
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29
Q

Give three fluids used for resusitiation

A

Balanced crystalloids (Hartmann)
NaCl (Saline)
Colloids

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30
Q

Give two fluids used for maintainence

A

5% glucose

5% glucose w saline

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31
Q

Give three symptoms of moderate hyponatreamia (121-129)

A

Cramps
Weakness
Nausea

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32
Q

Give 3 symptoms of severe hyponatreamia (<120)

A

Lethargy
Headaches
Confusion

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33
Q

Give three symptoms of severe and rapidly evolving hyponatreamia <120

A

Seizures
Coma
resp arrest

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34
Q

Give 4 causes of euvoleamic hyponatreamia

A

Water intoxication
Hypothyroid
Hypopituatary
SIADH (eg from small cell lung cancer)

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35
Q

What are daily maintainence requirements of fluid, sodium, potassium and chloride?

A

Fluid 25-30ml/kg/day

Salts 1mmol/kg/day each

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36
Q

Give 6 signs of hypovoleamia

A 
Fast weak pulse
Postural drop of >20mmhg 
Low BP
Loss of skin turgor
Sunken eyes
Dry mucus membranes
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37
Q

Give 5 signs of hypervolemia

A 
Fast, bounding pulse
High BP (but may be low!)
Periferal odema
High JVP
Ascites
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38
Q

Give three fluids used for resusitiation

A

Balanced crystalloids (Hartmann)
NaCl (Saline)
Colloids

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39
Q

Give two fluids used for maintainence

A

5% glucose

5% glucose w saline

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40
Q

Give three symptoms of moderate hyponatreamia (121-129)

A

Cramps
Weakness
Nausea

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41
Q

Give 3 symptoms of severe hyponatreamia (<120)

A

Lethargy
Headaches
Confusion

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42
Q

Give three symptoms of severe and rapidly evolving hyponatreamia <120

A

Seizures
Coma
resp arrest

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43
Q

Give 4 causes of euvoleamic hyponatreamia

A

Water intoxication
Hypothyroid
Hypopituatary
SIADH (eg from small cell lung cancer)

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44
Q

Give three non renal (urine na <25mmol/l) hyponatreamia

Hypervolemic

A

Congestive heart failiure
Cirrhosis
Nephrotic syndrome

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45
Q

Give a renal (urine na >30 mmol/l) cause of hyponatreamia

Hypervoleamic

A

CKD (kidneys fail to excrete water but not na)

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46
Q

Give three non renal (urine na<25) of hyponatreamia

Hypovoleamic

A

GI loss
Dermal loss (sweat)
3rd spacing of fluids

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47
Q

What is the management for hypovoleamic hyponatreamia?

A

0.9% IV saline

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48
Q

What is management for euvoleamic or hypervoleamic hyponatreamia?

A

Treat underlying cause

Fluid restriction

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49
Q

Give two causes of hypernatreamua due to sodium overload

A

Administration of high salt load by IV fluids

Hyperaldosteronism (conns disease = primary hyperaldosteroneism)

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50
Q

What’s the management for hypernatreamia?

A

Give hypotonic fluid eg 5% dextrose slowly to dilute it

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51
Q

Give 3 symptoms of hyperkaleamia

A

Muscle weakness/paralysis
paraestheasia
Arrhythmia

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52
Q

Give 3 treatments for hyperkaleamia

A 
Insulin + glc (insulin drives potassium into cells)
IV calcium (antagonises K effect of cardiac membranes)
Remove K+ via loop diuretics or heamodyalysis
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53
Q

give 4 causes of hypokaleamia

A

reduced intake
Entry into cells due to alkalosis
GI/urine/sweat loss
Hyperaldosteronism

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54
Q

give 4 clincal manifestations of hypokaleamia

A

Muscle weakness
ECG changes
Renal abnormalities
rhabdomyelisis

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55
Q

Give 3 ECG features typical of hypokaleamia

A

U wave
ST depression
flat T wave

long QT
PR elongation

(U DEPRESSED Fam)

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56
Q

give 4 causes of high anion gap metabolic acidosis

A

ketoacidosis
lactate acidosis
renal failiure!! (eg. in AKI)
Toxins eg. asprin

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57
Q

Give 3 causes of normal anion gap metabolic acidosis

A

Diahorrea
Surgical drains
Renal tubular acidosis

All due to loss of Hco3 without gain of other unmeasureable anions

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58
Q

Is COPD eaosinophilic or non?

A

non eosinophilic

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59
Q

Give 3 main symptoms of COPD

A

Sputum
Wheeze
Dyspnea

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60
Q

What is Cor pulmonal?

A

Enlargement of R heart due to lung disease (occurs in COPD)

Due to reflexive vasoconstriction due to low pO2 in lungs

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61
Q

Give 5 lung number changes in COPD

A 
inc resp rate
inc FRC
inc residual volume
dec inspiratory capacity
dec inspiratory reserve volume
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62
Q

Give 5 airway changes in COPD

A 
Chronic Bronchitis
Emphysema
Cillia destuction
increased goblet cells 
Bronchial submucosal gland hyperplasia/dysplasia
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63
Q

Give 3 inflammatory cells in COPD

A

Neutrophil
CD8
fibroblast

(Not Eosinophil!)

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64
Q

what is the most common microorganism causing pneumonia?

A

Strep. Pneumoniea

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65
Q

give 5 factors that score a point in the CURB65 scoreing system for pneumonia?

A 
confusion
serum urea >7mmol
Resp rate >30
BP below 90 systolic or 60 diastolic
aged 65 or older
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66
Q

Give 4 common causes of community aquired pneumonia

A

strep pneumonia
Viral (influenza a/b)
Staph Aureus
Heamophilus influenzae

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67
Q

What Abx should be added if a pateint for pneumonia has risk factors for MRSA

A

Vancomycin

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68
Q

What pathogen causes legionaires disease?

A

Legionella pneumophillia

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69
Q

What is non pneumonia legionella infection called?

A

Pontiac fever

70
Q

What is typical history exposure suggesting legionaires?

A

Water exposure

71
Q

in addition to pneumonia symptoms, what are the 2 classic signs of legionaires?

A

prominent headache

fever w/o tachycardia

72
Q

What Abx class should you use for legionaires disease? 2 available

A

fluroquinolone (eg. levofloxacin)

Macrolide (eg. axithromycin)

73
Q

give 2 common organisms causing atypical pneumonia

A

Mycoplasma pneumoniae

Chlamydophila pneumoniae

74
Q

give a typical symptom of atypical pneumonia

A

hoarseness

75
Q

What demographic does atypical pneumonia typically affect?

A

young adults living in close proximity

76
Q

What antibiotic should be used for athypical pnemonia?

A

Macrolides (eg. azithromycin)

- standard pneumonia treatment includes this for coverage as penicillin wont work on these

77
Q

Give two common organisms causes hospital aquired pneumonia

A

Psudomonus Aeruginosa

E. Coli

78
Q

Give 4 causes of immunocompromise causing increased pneumonia susectibility

A 
neutrophil defect (chemo therapy)
Abx defect (primary immune deficiency)
T cell defect (HIV)
High does steroid (eg for rheumatoid artheritits)
79
Q

What is the antifungal of choice for aspergillus infection of lungs?

A

Voriconazole

80
Q

Give three causes of pneumonia specific to immunocompromised patients

A

Aspergillus
Nocardia
Pneumocystis jiroveci

81
Q

What is the CT finding in Aspergilllus infection

A

‘halo sign’ - circle like structures in lungs

82
Q

What type of immunocompromise is typically seen in patients with nocardia

A

T cell eg. HIV, high dose steroids, post transplant

83
Q

what abx do you use to treat nocardiosis and pneumocystis jirovecci?

A

septrin (a combination)

84
Q

is asthma, what does IL-13 do?

A

Mucus hypersecreation

85
Q

In asthma, what does IL-5 do?

A

Attacts and degranulates eosinophils

86
Q

Give four signs of infective endocarditis

A

Fever
Murmurs
Vegetations on echo (lesions)
Positive blood cultures (commonly staph aureus)

87
Q

What two types of hypersensitivity is asthma?

A

type 1 and type 4

88
Q

give two actions of histamine released from mast cells in asthma

A

Vasodilation (causes mucosal odeama)

Bronchoconstriction

89
Q

Give two actions of tryptase is asthma

A

remodels tissue

mucus hypersecreation

90
Q

give two functions of the de novo produced prostaglandin (PGD2) in asthma

A

vasodilation

bronchoconstriction

91
Q

Give one function of leukotrienes de novo produced by mast cells in asthma

A

bronchoconstriction

92
Q

give four outcomes of the tissue remodeling in asthma due to tryptase

A

epithelial cell damage causing odema
BM thickening
Airway SM thickening
Mucusgland hypertrophy

93
Q

What is the normal function of eaosinophils

A

killing of extracellular parasites

94
Q

what two classes of bronchodilators are used in asthma

A

B2 agonists

anticholinergics/antimuscarinics

95
Q

give three long acting beta 2 agonists used in asthma

A

vilanterol
salmetorol
formoterol

96
Q

give 2 anticholinergics used in asthma bronchodilation

A

ipratropium

tiotropium

97
Q

give one inhaled corticosteroid used in asthma

A

Fluticasone

98
Q

what class of drugs can be used instead of ICS (inhaled corticosteroids) i asthma for children

A

Leukotriene Receptor Antagonists (LTRA)

eg. Nedocromil

99
Q

What three types of hepatitis virus are likely to cause chronic infection

A

B,C,D

100
Q

what type of drug is bendroflumethiazine?

A

thiazide diuretic

101
Q

Give two potassium sparing diuretics

A

amiloride

spirolactone

102
Q

Give 5 drug classes to give in urgent/severe asthma exacerbation

A 
SABA
Anticholinergic (ipatropium bromide)
O2
Corticosteroid (Oral or IV) - Prednisolone 
IV magnesium
103
Q

How long should one canister of inhaled corticosteroid last for a asthma patient?

A

1 month

104
Q

What organism most likely causes infective endocarditis from dental procedures?

A

Strep. Viridans

105
Q

What organism is the most common cause of infective endocarditis? Esp in IVDU

A

Staph aureus

106
Q

Give four drugs/ classes that can causes SIADH

A

Sulphonylurea
SSRI
Tricyclic antidepressants
Carbamazapine

107
Q

What is the maximum safe rate to raises sodium in hyponatreamia

A

8mmol/d

108
Q

What does raising serum sodium too quickly put pt at risk of?

A

Central pontine myelinolysis

109
Q

What is the most common lower resp tract infection in <1 yros and what is the causative organism?

A

Bronchiolitis

Resp. syncytial virus

110
Q

Give four pharmocodynamic effects of propofol

A

Apnoea (30s to 30min)
Decreased CO and TRP (therefore decreaed BP)
decrased ICP (allows for normal CPP with the lower BP)

antiemetic

111
Q

Give three barbiturates

A

Thiopental
Methoxital
Phenobarbital

112
Q

Give four pharmocodynamic effects of barbiturates

and what system is it protective of?

A

Apnoea
Decreased CO (periferal vasodilation and -ve ionotropy)
decreased ICP and cerebral o2 demand

seizure supression

Overll, good neuroprotective eg. good for head trauma

113
Q

give three pharmacodynamic effects of benzodiazepines

and what system are they protective of?

A

No apnoea (but decreased upper airway tone)
Only v small BP drop
anticonvulsant
Anxiolysis (reduces anxiety)

V cardioprotective - heamodynamically stable

114
Q

Give a benzodiazepine antagonist

A

Flumezanil

115
Q

Give three pharmacodynamic effects of ketamine and on what patients is it good to use of?

A

No apnoea
Increased BP, HR, CO
Increased ICP, cerebral metabolic O2 demand

Good for heamodynamically unstable Pts

116
Q

Give three pharmacodynamic actions of etomidate and for what patients is it good for?

A

transient hyperventiation followed by apnoea
raised BP
decreased ICP

Good fro heamodymically unstable Pts

117
Q

Give two pharmacodynamic effects of dexmedetomidine and what patients is it good for?

A 
No apnoea or resp depression
decreased CO (bradycardia)

Good for awake craniotomy

118
Q

Give 6 pharmacodynamic effects of morphine

A 
huge resp suppresion
cardio stable
sedation/euphoria
constipation
pruritis
Biliary constriction
119
Q

Give the 4 main opioids in order of potency

A

Fentanyl
Morphine
Codine
Tramadol

120
Q

Which opioid has the shortest action (cotext sensitive half life)

A

Remifentanyl

121
Q

Which two induction agents raised the CO/BP so are good for heamodynamically unstable Pts?

A

Ketamine

Etomidate

122
Q

Which two induction agents casue apnoea, decreased BP and decreased ICP?

A

Propofol

Barbiturates

123
Q

Give two cardiac complications of bicuspid aortic valve

A

Aortic stenosis

Aortic regurgitation

124
Q

Give two disgnostic findings suggestive of mitral stenosis

A

(late) Diastolic murmur

May have irregularly irregular heartbea - like AF

125
Q

Give four cardiovascular complications which may occur in Marfans

A

Aortic dissection
Aortic Aneurysm
Aortic regurgitation
Mitral Prolapse

126
Q

Apart from height, give two feature of sppearence of Marfans

A

High Arched Palette

Scoliosis

127
Q

What arrhythmia is an indication for a permanant pacemaker?

A

3rd degree heart block

128
Q

Give two ECG findings of NSTEMI

A

T wave inversion

ST depression

129
Q

Rheumatic fever is a complication of what infection?

A

Streptococcal pharyngitis

130
Q

Wha vavular defect is a common complication of rheumatic fever?

A

Mitral Stenosis

131
Q

Give 2 ECG features of pericarditis

A

PR depression

Saddle Shaped ST elevation

132
Q

Give four causes of pericarditis?

A

Viral infection
Dressler’s syndrome - post MI
TB
ureamia

133
Q

Give three signs/symptoms of Pericarditis

A

Peuritic chest pain (stabbing, worse on inspiration)
Alleviated by sitting forward
Pericardial rub

134
Q

What is S3 heart sound usually a sign of?

A

systolic heartfailiure but may be normal eg in pregnancy or atheletes (increased complience)

135
Q

What is S4 heart sound usuallya sign of?

A

Diastolic heart faililure- hypertrophy. Also may be due to active ischeamia (caused by decreased complience)

136
Q

When does a physiological spilt of S2 happen?

A

Inspiration

137
Q

What does a fixed spil of S2 suggest

A

Atrial septal defect

138
Q

What does a paradoxical split of S2 suggest?

A

Aortic stenosis
Left bundle branch block
(any condition resulting in a delay in Aortic closure)

139
Q

What does a widened S2 split suggest?

A

RBBB
Mitral regurg
(any condition that casues a delay to pulmonary closure or early aortic closure)

140
Q

What does a mid systolic click suggest

A

Mitral prolapse

141
Q

How do you treat AKI caused by acute interstitial nephritis

A

steroids

142
Q

Give 2 formulea used to estimate GFR from serum creatinine and which is better?

A

MDRD (better and more commonly used)

Cockroft and Gault

143
Q

Why would you give Epo injections in CKD

A

For renal aneamia (Epo is the activated for of erythropoetin)

144
Q

What is IgA nephropathy and give 4 symptoms of it

A 
IgA deposition in kidneys causing glomerularnephritis
Microscopic heamaturia
HTN
Proteinurea
Progressive renal impairment
(Ix with serum IgA)
145
Q

What genetic condition causes glomerulonephritis (with universal heamaturia) and hearing loss

A

Alports disease

146
Q

Give 2 macrolides

A

Azithomycin

Erythromycin

147
Q

Give the class of and an example of the Abx used in serious sepsis

A

Gentamycin

class is aminoglycosides

148
Q

give two glycopeptides and are they better against gram +ve or -ve?

A

Vancomycin (used against MRSA)
Teicoplanin
only work aginst +ve

149
Q

Give two Quinolones (flouroqinolones) and state is theyre better against gram +ve or -ve

A

Levoflouracin
Ciproflouracin

Better agianst -ve (used in legionaires)

150
Q

Give 7 signs of tension pneumothorax

A 
Resp distress
tachycardia
hypotension
distended neck veins
increased resonance
decreased breath sounds
trachea devated away
151
Q

Give two features that may suggest tension over normal pneumothorax

A

Trachea deviated away

distended neck veins

152
Q

What is Becks triad for Cardiac tamponarde

A

Raised JVP
Falling BP
Muffled Heart Sounds

153
Q

what would tousarde de pointsshow on ECG?

A

Rapid, irregular QRS that twist around the baseline

154
Q

What ECG abnormality is Tousarde de points associated with?

A

Long QT

155
Q

Give 7 post MI complications

A 
VT
Pericarditis
papillary muscle dysfunction
mural thrombosis
ventricular rupture -> tamponarde
ventricular anurysm
dressler syndrome
156
Q

What 2 examination findings are typical in restrictive lung disease

A

Clubbing and crackles

157
Q

How do you differentiate ideopathic pulmonary fibrosis and non-specific interstital pneumonia (3 things)

A

Non specific interstitial pneumonia is autoimmune associated (eg lupus), has ground glass opacities in CT and has no honeycombing

158
Q

What happens in sarcoidosis

A

non ceasating granulomatous inflammation affecting the lungs, eyes and skin (may produce a interstitial lung disease)

159
Q

are left sided murmurs louder on inspiration or expiration and vice versa?

A

Left sided = louder on expiration

right sided = louder on inspiration

160
Q

Give 2 blood changes that may occur in shock?

A

increased neutrophils

decreased coagulation time

161
Q

give the four stages of shock classfication (according to %blood lost)

A 
1 = 0 -15%
2 = 15-30%
3 = 30-40%
4 = >40%
162
Q

Give three treatments for Delayed sleep phase disorder?

A

Phototherapy
Low dose melatonin
CBT

163
Q

How is shift work disorder diagnosed?

A

Insomnia/ excessive daytime sleepiness for over 1 month

Diagnosis of exclusion

164
Q

During which halves of the night do NREM and REM parasomnias happen (respectively)

A 
NREM = 1st half
REM = 2nd half
165
Q

What is the overall cause of concentric hypertrophy and give 2 specific causes of this?
Give the basic process of concentric hypertrophy

A

Pressure overload
HTN, Aortic stenosis

Wall bulks up, radius decreases, whole thing dilates

166
Q

What is the overall cause of dilated cardiomyopathy and give 1 specific causes of this?
Give the basic process of dilated cardiomyopathy

A

Volume overload
Aortic regurgitation

wall bulks up, radius also increases

167
Q

Give 3 reasons why COPD presents with breathlessness

A

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)

168
Q

Which is eosinophilic, COPD or asthma?

A

Asthma

169
Q

give 3 KDIGO definition of AKI

A 
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
170
Q

Give 3 consequences of retention of metabolic waste product in AKI?

A

Encephalitis
Pericarditis (may progress to tamponarde)
pleurisy

171
Q

What is the overall process that causes type 1 resp failiure?

A

VQ mismatch (eg. pulmonary odema, PE, pneumothorax)

172
Q

What is the overall process that causes type 2 resp failiure?

A

Disruption of the ventilatory apparatus (eg. stoke, fail segment ect.)

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