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30 Cards in this Set
- Front
- Back
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What is the score used to assess risk of aortic dissection? |
Aortic Disease Dissection Risk Score |
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What are the high risk conditions, high risk pain features and high risk exam features of aortic dissection? |
Conditions - Marfans/connective tissue disorders, aortic valve disease, known thoracic aortic aneurysm, prev aortic manipulation. Pain features - any chest/back/abdo pain described as abrupt, severe intensity, ripping, tearing. Exam features - perfusive deficit - (pulse deficit, systolic BP difference) neurology, aortic diastolic murmur (new), shock
High risk more than or equal to 2 features present - urgent CT, referral to surg. 0-1 - ddimer and cxr |
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Suspect endocarditis if fever + any of these ... |
-hx of endocarditis -hx IV drug use -cardiac - new conductive disease, new HF, new valve disease - vascular or immunologic phenomena - Roth’s spots, oslers nodes, embolic events, janeway lesions -peripheral abscess - renal, spleen, vertebral, central -PE -non specific neuro |
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What is the criteria for Endocarditis? |
Duke's Criteria: Pathological - microorganism on culture/histology from vegetation/embolised vegetation/abscess OR Histologic specimen from vegetation/intracardiac abscess showing active endocarditis MAJOR - x2 +ve Blood Cultures in 12 hours apart, Evidence of endocardial involvement (new murmer, echo) Diagnostic : 2 Major Criteria and 0 Minor CriteriaDiagnostic : 1 Major Criteria and 3 Minor CriteriaDiagnostic : 0 Major Criteria and 5 Minor Criteria MINOR - fever >38, vasc phenomona, immun phenomona, predisposition to IE |
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How does Myocarditis present |
Viral illness - elevated inflamm markers, elevated Trops Fever, SOB, palps Mild CP HF Can have life-threatening cardiogenic shock |
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ECG changes with myocarditis |
Widespread concave ST segment elevation AV block QRS prolognation |
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Causes of myocarditis |
Infections, Autoimmune disease, thyrotoxicoseis, hypersensitivity reaction, alcohol. |
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How does pericarditis present? What are the treatments? |
Chest pain, sharp, pleuritic, relieved on sitting forward, pericardial rub and effusion. Treated with NSAIDs, Colchicine (poor prognosis if Temp >38, effusion/tamponade, failure of NSAID treatment) |
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What is the single best predictor for HF? |
Previous MI – when present the likelihood of CHF is 21 times greater
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What are diagnostic features of HF? |
Dyspnoea on minimal exertion, fatigue, presence of risk factors (old age, male, previous heart disease, smoker, diabetes etc), Major Framingham criteria - Neck vein distension, 3rd heart sound (S3 gallop), Cardiomegaly, dilation, or hypertrophy, Hepatojugular reflux, Lung crepitations Minor Framingham criteria - Ankle oedema, Tachycardia >120 beats/min, Hepatomegaly, Night cough, Pleural effusion (less than one third maximum vital capacity) |
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Investigations for heart failure |
Baseline bloods - eg renal profile, FBC, TFTs, LFTs, HbA1C BNP ECG CXR echo Consider Spirometry |
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Initial treatment for heart failure |
Ace inhibitor eg Cilazapril 0.5mg OD Beta blocker eg Metoprolol 23.75 mg OD |
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What is syncope? |
Transient loss of consciousness due to transient global cerebral hypoperfusion characterized by rapid onset, short duration, with spontaneous and complete recovery
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What is it the one investigation that everyone (Except young people with very obvious cause) should get if they have had an episode of syncope |
ECG |
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What are the high risk features for patient presenting with syncope which means should be admitted to hospital? |
Age ≥ 65 years ECG abnormalities (new or previously unknown) LBBB, bifascicular block + first degree AV block, Brugada ECG pattern, changes consistent with acute ischemia, Non-sinus rhythm (new), prolonged QTc (450 ms) History or presence of heart failure, IHD or structural heart disease Syncope while supine, during exercise, or without prodromal symptoms Dyspnoea Hypotension (SBP < 90 mm Hg) Haematocrit <30%Male sex Evidence of haemorrhage (blood on DRE) Family history of sudden death aged < 50 years |
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What are the three types of AF? |
Paroxysmal, Persistant, Permanent |
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Advantages or Disadvantages of Warfarin and Dabigatran |
Warfarin - Advantages: Can take with renal failure, reversible in primary care, no long-term side-effects. Disadvantages: Requires monitoring, multiple drug interactions, bleeding risk. Dabigatran - Advantages - no monitoring, no drug interactions, lower risk of ICH Disadvantages - not reversible in primary care, reduced dose in renal impairment, contraindicated mechanical valve |
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What is the Well's criteria for DVT? |
Bedridden for more than three days or surgery within the last four week+1 Tenderness along line of femoral or popliteal veins (NOT just calf tenderness)+1 Entire limb swollen+1 Calf more than 3cm bigger circumference,10cm below tibial tuberosity+1 Pitting oedema+1 Dilated collateral superficial veins (non-varicose)+1 Past Hx of confirmed DVT+1 Malignancy (including treatment up to six months previously)+1 Intravenous drug use+3 Alternative diagnosis as more likely than DVT-2 If the score is low <2 proceed to perform a DDIMER and if age adjusted negative DVT is likely to be excluded. If the score is high >=2 then further investigation is warranted before or during anticoagulant therapy. Ultrasound is the usual investigation of choice to confirm DVT. |
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Symptoms of a PE? |
haemoptysis
pleuritic chest pain feeling non specifically unwell SOB symptoms of DVT Collapse PEA Sudden Death The symptoms are often very non specific making it harder to diagnose. |
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What can be used to exclude PE? |
PERC rule (if scores 0, <2% chance of PE) |
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What are symptoms of hyperglycaemia? |
polydipsia
polyuria fatigue weight loss abnormal healing blurred vision increased occurrence of infections, particularly those caused by yeast. Patients may also present in DKA or HHS |
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What would be the features of a patient with hypothyroidism? |
slow mental activity with poor memory
slow physical activity apathy weakness, lethargy, fatigue, muscle weakness muscle cramps, arthralgias cold intolerance (may also have heat intolerance due to impaired sweating) constipation weight gain(usually <10% of total body weight) despite decreased appetite (although some patients have weight loss due to anorexia )dry coarse skin (ichthyosis) and hair loss menstrual irregularities (menorrhagia, dysfunctional uterine bleeding, infertility)rarely voice changes such as hoarse voice (laryngeal myxoedema), slow speechhearing loss (middle ear myxoedema)decreased libido. |
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What in patient's history may make hypothyroidism more likely |
Other Autoimmune diseases (T1DM, Addisons, coeliac), Genetic condition (Downs, Turner), Treatment with radioactive iodine or thyroid surgery, radiotherapy head and neck |
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Common causes of hypothyroidism |
Primary - low iodine diet, Autoimmune, Hashimoto's thyroiditis Central - pituitary adenoma Surgery Congenital |
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Presentation of hyperthryoidism |
Symptoms of increased basal metabolic rate: Cardiac: tachycardia, atrial fibrillation, hypertension, HF due to thyroid storm General: weight loss, moist skin, hair loss, hair thinning Eyes: stare, exophthalmos (proptosis), incomplete eyelid closure with cornea still visible (may lead to corneal ulceration and vision loss), ophthalmoplegia, head tilt to compensate for double vision Goitre |
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Causes of hyperthyroidism |
Graves, Toxic Adenoma, Multinodular goitre, Cancer, De Quervain's thyroiditis |
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What clinical and lab findings would be suggestive of a thyroid storm? |
Raised T3 and/or T4
CNS: restlessness, delirium, mental aberration/psychosis, somnolence/lethargy, seizure, GCS ≤ 14 Fever ≥ 38 degrees C Tachycardia ≥ 130/minute Heart failure with pulmonary oedema GI: nausea, vomiting, diarrhea or raised bilirubin |
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What is the treatment of Osteoarthritis? |
Lifestyle measures eg regular gentle exercise, weight loss, physiotherapy Paracetamol NSAIDs Cox-2 inhibitors Steroid injection Joint replacement |
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Difference between gout and pseudogout? |
Gout - monosodium urate crystals on aspiration, tophi, mainly affect 1st MTP/ankle/knee Pseudogout - calcium pyrophosphate crystals on aspiration, no tophi, affect knees/ankles/wrist/elbows |
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What are some poly-articular causes of arthritis? |
Reactive arthritis (follows GI/GU infection, lower joints > upper joints, assoc keratitis) Rheumatoid arthritis (morning stiffness, polyarticular, nodules, ymmetric pain and swelling of the small joints (particularly of the hands) is the most frequent finding. Initial symptoms may be systemic (e.g. fatigue, malaise, diffuse musculoskeletal pain), with joints becoming involved later. Asymmetric presentations (often with more symmetry developing later) are not uncommon.Morning stiffness IS a clinical feature of synovitis and is related to the accumulation of edema fluid within inflamed tissues during sleep. This resolves as edema and inflammatory products are absorbed by lymphatics and venules and returned to the circulation. |
