The big 6 Flashcards
What is STEMI?
ST elevated myocardial infarction
What is the pathophysiology of STEMI?
Complete and persistent occlusion of a major coronary artery causing cell death due to ischaemia.
What is the cause of STEMI?
Oxygen demand has exceeded oxygen supply.
What are the risk factors for STEMI?
Increasing age Male Family history Smoking Poor diet Diabetes mellitus Hypertension Hyperlipadaemia.
What are the symptoms for STEMI?
Severe Angina: Crushing chest pain Radiation to left arm, neck and jaw. Dyspnoea Sweating Vomiting Syncope
What would be found upon examination of a patient with STEMI?
Tachycardia
Cardiogenic shock
What investigations are used to diagnose STEMI?
ECG - st segment elevation which may progress to the q wave.
Serum cardiac troponin
CXR
ECHO
What treatment is there available for STEMI patients?
Angioplasty if available within 2 hours - stent opens coronary artery via inflating a balloon.
Thrombolysis - pharmacological treatment used to catalyse plasminogen to lyse the fibrin clot.
Immediate MONA - morphine, oxygen, nitroglycerin and aspirin.
What is the secondary treatment used to prevent further STEMI?
Lower cholesterol - Statins
Lower oxygen demand of heart - Beta blockers
Antiplatelet - Aspirin and Clopidogrel
Lower BP - ACE inhibitors.
What is DVT?
Deep Vein Thrombosis
What is the pathophysiology of DVT?
A blockage arising in deep veins, usually the legs. Clot can migrate from another area and can be blood,fat ,air , tumour.
What causes DVT?
Stasis in deep veins and hypercoagubility.
What are the risk factors for DVT?
Increasing age Tissue trauma Immobility Obesity Smoking Pregnancy Oral contraceptive Systemic disease Thrombophilia
What are the symptoms for DVT?
Unilateral limb swelling Persistant discomfort Calf tenderness Warmth Erythema - redness Prominent collateral veins Pitting oedema
Upon examination of a patient with expected DVT what would you see?
Unilateral limb swelling
Pitting oedema
Redness
What investigations aid the diagnosis of DVT?
Clinical probability assessment (wells scoring) :
0=low risk
1-2=moderate
3 + =high risk
D-dimer blood test: positive indicates DVT but does not confirm it. negative rules out DVT.
Compression ultrasound: can see location and size of obstruction.
What is the available treatment for DVT?
Low molecular weight heparin - anticoagulant that prevents further clots.
Compression stockings - increases blood flow through veins in legs.
Thrombolysis/thrombolectomy - extreme cases.
What is stable angina?
Chest pain due to ischaemia of heart muscle.
What causes angina?
Blood issues:
obstructive atheroma
coronary artery spasm
coronary arteritis
Oxygen supply:
Anaemia
Increased Oxygen demand:
Left ventricular hypertrophy
Thyrotoxicosis
What are the risk factors for angina?
Non-modifiable: Increasing age Race Male Family history Genetics
Modifiable: Smoking Exercise Diet Diabetes Hypertension Hyperlipadaemia
What are the symptoms of angina?
Retrosternal chest pain that feels crushing/heavy.
Radiation to neck/jaw/arms
Dyspnoea on exertion
Symptoms get worse during cold weather, after a large meal, after exercise. They are relieved by rest and GTN spray.
What would be seen on the examination of a patient with suspected angina?
Tar staining Obesity Xanthaslasma Corneal arcus Hypertension Retinopathy AAA Heart failure Basal crackles Peripheral oedema Mitral regurgitation Aortic stenosis
What are the investigations that aid the diagnosis of angina?
Full blood count Lipid profile Blood glucose Thyroid Electrolytes LFTs CXR ECG Exercise tolerance test Myocardial perfusion imaging Coronary angiography
What is the treatment available for angina?
Control of symptoms; Beta blockers Calcium channel blockers K+ channel blockers Nitrates (GTN)
Disease treatment:
Statins
ACE inhibitors
Aspirin or Clopidogrel
Revascularisation:
PCI - percutaneous coronary intervention
CABG if multi-vessel.
What is tuberculosis?
A bacterial infection that is spread through inhaling tiny droplets of cough and sneeze from an infected individual. Mainly affects the lungs.
What causes tuberculosis?
Mycobacterium tuberculosis
Helper T cell response eliminates mycobacteria but activates macrophages that cause tissue destruction.
What are the risk factors for TB?
Increasing age Malnutrition Immunosuppressed Diabetes Recent immigrants from high prevalence countries.
What are the symptoms of TB?
Persistan cough Sputum production Haemoptysis Swollen lymph glands Weight loss Loss of appetite Fever Night sweats Crackles Bronchial breathing.
Latent TB is much more progressive when it becomes active.
What are the investigations that aid the diagnosis of TB?
CXR - patchy opacities often bilateral and favouring apices of lobes. Cavitation if advanced and calcification if chronic/healed TB.
Sputum culture - to find organism
CT Thorax
Bronchoscopy
Pleural aspiration and biopsy.
Full blood tests
What is the treatment available for TB?
Multidrug therapy lasting at least 6 months. Considered non infectious after 2 weeks.
For 2 months: Rifampicin Isoniazid Ethambutol Pyrazinamide
For 4 months:
Rifampicin
Isoniazid
What is pulmonary neoplasia?
Lung cancer - the proliferation of mutated cells within the lung.
Primary lung cancer is when the cancerous tissue develops in the lung.
Secondary lung cancer is when cancer from elsewhere in the body spreads to the lungs.
What are the different types of lung cancer?
Non-small cell lung cancer makes up 80% of cases. Can either be Adenocarcinoma, Large cell carcinoma or squamous cell carcinoma.
Small cell lung cancer makes up the other 20% of cases. It is a more severe form of cancer that spreads faster than non-small cell cancers.
What are the symptoms of Lung Cancer?
Asymptomatic in early stages Persistant cough Dyspnoea Haemoptysis Sputum Fatigue Weight loss Loss of appetite Hoarse voice
What are the investigations that aid the diagnosis of Lung Cancer?
Chest x-ray - to locate tumour.
CT scan/PET CT - helps with staging of cancer.
Bronchoscopy to try and get a direct look at cancer
Biopsy
Full blood tests
EBUS.
What is the treatment available for lung cancer?
Surgery - only an option if caught early enough, cancer hasn’t spread, patient is fit enough.
Radiotherapy
Chemotherapy
Palliative care
Prognosis isn’t good as most cancers aren’t detected until later stages when it is too late.
EGFR,BRAF,ALK and ROS1 have target agents approved for immunotherapy.
What is Asthma?
A hypersensitivity reaction that causes the airways to narrow, making it harder for oxygen to get in and out of lungs.
What causes Asthma?
Hypersensitivity reactions stimulate mast cell degranulation.
Release of histamine causes smooth muscle contraction of airways and bronchial hyper-reactivity/inflammation.
Inflammation creates a build up of mucus.
What are the risk factors for Asthma?
Atopy - eczema, hay-fever, other allergies
Family history
Occupation
Smoking
What are the symptoms of Asthma?
Dyspnoea Cough Wheeze Chest tightness Sputum
What are the features of Asthma symptoms that distinguish it from other respiratory conditions?
Symptoms are variable - they come and go
Symptoms are reversible - can get better
Symptoms get worse at night/cold weather/during exercise/triggers.
What investigations aid the diagnosis of asthma?
Spirometry Peak flow CXR Bronchoscopy Response to beta 2-agonist steroids.
What treatment is available for Asthma patients?
Mainly inhalers:
1- SABA - salbutamol (reliever)
2- Add low dose ICS - beclomethasone, budesonide
3- Add LABA - formoterol, fostair, symbicort, flutiform
If no response to LABA try LTRA - Montelukast, Zafirlukast
4- Increase ICS dose
5- Add daily steroid tablet.
What are some examples of oncogene mutations causing lung cancer?
KRAS - smoking induced EGFR BRAF HER2 ALK ROS1
Where is primary lung cancer likely to spread in the body?
Liver Lymph nodes Adrenals Bone Brain Skin
What are some local effects of lung cancer?
Bronchial obstruction Pneumonia Infection/abscess Bronchiectasis Pleural inflammation Chest wall invasion
What is meant by TNM staging?
Method of calculating how far on a cancer is.
T= Tumour
N= Nodes - has it spread to lymph nodes
M= Metastases - has it spread anywhere else
T0=no primary tumour T1=small T2= 3-5cm tumour T3= 5-7cm tumour T4= large tumour
N0=not spread to nodes
N1=near by lymph nodes
N2=2 lymph node affected
N3= 3 or more lymph nodes affected
M0= not spread
M1a=another tumour nodule formed
M1b=single metastases in distant area
M1c=multiple metastases in distant areas
