Tuesday [16/5/23] Flashcards
causes of slow onset tinnitus [7]
presbycusis, ear wax and otosclerosis
[x10 less likely]
meniere’s diseas
sudden-onset sensorineural hearing loss
[x100 less likely]
vestibular schanwannoma
idiopathic intracranial hypertension
what is presbycusis? [1]
age-related hearing loss, occurs gradually as we age
Sx of presbycusis
progressive, irreversible bilateral symmetrical age-related sensorineural hearing loss resulting from degernation of the cochlea
what is otosclerosis? [2]
abnormal bone formation in one of the tiny bones in the middle ear, unsure why it happens but often due to hereditary, complication from having a virus, possible SE of low fluoride levels
Sx of otosclerosis [5]
hearing loss, speaking softly, hearing better in noisy surroundings, hearing sounds within your own body, dizziness and balance problems
causes of B/l lower limb oedema [2]
chronic heart failure
chronic kidney disease
[x10 less likely in]
ankle sprain, DVT, PE
[x100 less likely in]
membranous glomerulonephritis, amyloidosis, focal segmental glomerulosclerosis
Mx of chronic heart failure
first-line is both ACE-inhibitor and beta-blocker. Generally one should be started at a time.
Secon-line is aldosterone antagonist, ARB or hydrazaline in combination with nitrate.
If Sx persist, cardiac resynchronisation therapy or digoxin.
diuretics for fluid overload.
labatory features of osteomalacia
Osteomalacia is the correct answer. The clinical features (widespread bone pain and proximal myopathy), and laboratory features (low serum calcium, low serum phosphate, raised ALP and raised PTH) are classic of this disorder.
what should be checked with low calcium? [1]
vitamin D levels and whether to give supplemntation
bloods in hyperparathyroidism
primary = increased calcium, normal or raised PTH, increased vitamin D, decreased phosphate
secondary = decreased or lower calcium, increased PTH, low vitamin D, high phosphate
Sx for hyperparathyoidism
Symptomatic hyperparathyroidism
Asymptomatic hyperparathyroidism with any of the following:
24-hour urinary calcium > 400 mg (see footnote, below)
serum calcium > 1 mg/dl above upper limit of normal
Creatinine clearance > 30% below normal for patient’s age
Bone density > 2.5 standard deviations below peak (i.e., T-score of −2.5)
People age < 50
Indications for surgery for hyperparathyoidism
Symptomatic hyperparathyroidism
Asymptomatic hyperparathyroidism with any of the following:
24-hour urinary calcium > 400 mg (see footnote, below)
serum calcium > 1 mg/dl above upper limit of normal
Creatinine clearance > 30% below normal for patient’s age
Bone density > 2.5 standard deviations below peak (i.e., T-score of −2.5)
People age < 50
STEMI criteria
All patients who present with a suspected ACS must have an ECG within 10 minutes of first acute clinical contact
A clinician with ECG expertise should review the ECG
The immediate decision pathway then involves the ECG stratification of STEMI, from NSTEACS
STEMI minimum criteria:
STEMI is defined as presentation with clinical symptoms consistent with ACS (generally of ≥ 20 minutes duration) with persistent (> 20 minutes) ECG features in ≥ 2 contiguous leads of:
≥ 2.5 mm (i.e ≥ 2.5 small squares) ST elevation in leads V2-3 in men under 40 years, or ≥ 2.0 mm (i.e ≥ 2 small squares) ST elevation in leads V2-3 in men over 40 years
≥ 1.5 mm ST elevation in V2-3 in women
≥ 1 mm ST elevation in other leads
New LBBB (LBBB should be considered new unless there is evidence otherwise)
Findings in ACS
may be normal
classic changes in acute myocardial infarction
peaked T waves with ST elevation
gradual loss of R wave
development of pathological Q wave and TWI
anatomical localisation of ST elevation
Anteroseptal = LAD
Anterolateral = Cx
Inferior = RCA
Posterior = Cx or PDA (off RCA)
Minimal S-T changes can be difficult to interpret, especially in those with pre-existing CAD or other significant CVS disease. In such cases:
Comparison with old ECGs will be useful
Smith-Modified Sgarbossa Criteria can help if LBBB or paced:
≥ 1 lead with ≥1 mm of concordant ST elevation
≥ 1 lead of V1-V3 with ≥ 1 mm of concordant ST depression
≥ 1 lead anywhere with ≥ 1 mm STE and proportionally excessive discordant STE, as defined by ≥ 25% of the depth of the preceding S-wave.
In cases of LBBB urgent echocardiography may be useful, if readily available, to detect wall motion abnormalities (suggesting myocardial ischaemia) and hence assist in decision making
blood tests bone disorder CKD
decreased calcium, increased phosphate, increased ALP, increased PTH
paget’s disease bloods
normla calcium, phosphate, ALP and PTH
