Year 1 Flashcards
mild COPD
> 80 predicted
moderate COPD
30-49 predicted
severe COPD
<30 predicted
CURB65 criteria
confusion urea >7 RR >30 BP 90/60 65 yo
CAP: curb score 0-2
amoxicillin/doxycyclin
CAP: curb score 3-5
co-amox + clarithromycin/doxy, step down to doxy
HAP; non severe treatment
amoxicillin and metronidazole
HAP: serve
IV amox, met and gent, step down to coamoxiclav
tapping apex, mid diastolic rumble
mitral stenosis
describe aortic regurgitation
displaced apex, louder at LL edge on expiration and leaning forward
heaving apex, ejection systolic, radiates to axilla
mitral regurgitation
describe aortic stenosis
heavy apex, ejection systolic, radiates to carotids
pan systolic murmur, v waves
tricuspid regurgitation
inferior MI leads
2, 3, aVF
anteroseptal MI leads
V1-V4
anterolateral MI leads
1, aVL, V4-v6
lateral MI leads
1, aVL, V5-V6
heave, pulmonary mid-diastolic murmur
atrial septal defect
left to right shunt, loud pan systolic
ventricular septal defect
left to right shunt, machine like murmur
patent ductus arteriosus
decreased LL pulses
coarction of aorta
right to left shunt, boot shaped heart
tetralogy of fallot
baby born cyanosed, egg shaped ventricles
transposition of great vessels
most common food poisoning
campylobacter
bugs that cause outbreaks
e.coli, salmonella
viral diarrhoea in children
rotavirus
short incubation period
s.aureus, b.cereus
medium incubation period
salmonella, c.perfringerens
long incubation period
campylobacter, e.coli
bloody diarrhoea
shigella, campylobacter, e.coli
treatment of IBD
5-ASA steroids immunocompression Anti-TNF surgery
chrons disease
mouth to anus, skip lesions, fissures, TH1 mediated
UC disease
no skip lesions, crypt accesses, TH1 and TH2 mediated
albumin assesses what
synthetic function
what LFT assesses liver damage directly
AST/ALT
what hepatitis infection is DNA based
B
STEMI criteria
1mm elevation in 2 limb leads OR 2mm in 2 continuous chest leads OR new onset LBBB
treat an NSTEMI
aspirin 300
nitrates/morphine
clopidogrel 300 (continue for 12 months)
Fondaparinux
treat a STEMI
Fibrinolysis within 120 mins PCI within 12 hours of symptoms O2 if sats below 94 GTN IV Morphine metoclopramide aspirin 300mg
If patient receives fibrinolysis, do they need PCI?
if after 90 mins and ECG shows less than 50% ST resolution
describe a patient who has pericarditis
pleuritic chest pain, relieved by sitting forward, non productive cough
ECG changes in pericarditis
saddle shaped ST elevation
Angina treatment ladder
aspirin, statin, GTN PRN
1. b blocker + Ca channel blocker
if b blocker is contraindicated use Ca blocker as mono therapy.
2. still symptomatic add verapamil or diltiazem
3. add long acting nitrate (Ivabradine or nicorandil)
define recurrent AF
2 or more episodes
paroxysmal = self terminating, less than 7 days
persistent = more than 7 days
describe rate control in AF, when is rate control 1st treatment option
b-blocker, diltiazem, combination therapy, digoxin
rate first if over 65 or IHD history
drugs used for rhythm control in AF, when is rhythm control first line
amiodarone
flecanide (if no HD)
rhythm control first in under 65 years, 1st presentation of AF
describe Heart block type 1
pr interval longer than 0.2secs
describe Heart block type 2 (both types
Mobitz 1 - progressive elongation until a QRS drop
Mobitz 2 - PR interval unaffected, QRS does not always follow p wave
describe 3rd degree heart block
no association between p waves + QRS complex
define hypertension
140/90
stage 1 HTN
140/90 or ABPM 135/85
treatment of stage 1 HTN
advise lifestyle alteration
treat if end organ damage
Stage 2 HTN
Stage 3 HTN
stage 2: 160/100 or ABPM 150/95
stage 3: systolic 180 or diastolic 110
HTN treatment ladder
- under 55 = acei, over 55/black = C
- A+C
- A+C+D
resistant HTN: add alpha/b-blocker
if K<4.5 = spironolactone
K>4.5 = increase diuretic dose
what is malignant HTN?
describe management
medical emergency BP >200/130
M: atenolol oral, labetalol/nitropruside IV
most common cause of death post MI
ventricular fibrillation
what complication of MI is indicated by persistent ST elevation and LVF
left ventricular aneurysm
treatment of acute HF
Loop diuretic, morphine, nitrates, oxygen, posture
investigation of chronic HF
BNP measurement
less than 100 = HF unlikely
more than 100 = ECHO
Heart failure treatment
- ACEi + B-blocker
- spironolactone, ARB, OR hydralazine + nitrate
- digoxin or cardiac resynchronisation
management of tachycardia and adverse features
DC cardio version
management of broad complex tachycardia
regular - amiodarone
irregular - seek help
management of narrow complex tachycardia
regular - 1. vagal manoeuvres, 2. adenosine; 6, 12,12
irregular - AF (B-blocker, diltiazem)
management of bradycardia and adverse features
atropine 500mcg
what is Wolff-Parkinson White syndrome?
congenital accessory pathway between atria and ventricles leading to AV reentry tachycardia
what are the most common infective organisms in endocarditis
staph aureus is most common
s. epidermis in prosthetic valves
treatment of endocarditis
subacute native valve: amox + gent IV
severe native valve: flucloxacillin
prosthetic valve: vancomycin IV, rifampicin PO, gentamicin IV
