Block 31 Week 8 Flashcards

Question

which drugs can cause arrhytmias?

Answer 1

Taxanes and Anthracylines can cause arrhythmias

Answer 2

* pain * pathological fractures * hypercalcaemua * SCC

Answer 3

* activated osteoblasts stimulate production of RANK which activates osteoclasts * osteoclasts resorb bone -> osteolysis -> release of growth factors for tumour growth

Answer 4

* The mechanism of bone metastasis is seen radiologically; when bone-forming processes predominate the lesions appear blastic, * while if resorptive processes are dominant, the metastases appear lytic.

Answer 5

sclerotic (osteoblastic) metastases generally indicate a slower course

Answer 6

- lungs - liver - bone

Answer 7

* Among solid cancers, breast, prostate, lung, thyroid, and kidney cancer account for 80% of all skeletal metastases.

Answer 8

multiple myeloma

Answer 9

* Pain is the most common symptom * usually picked up during the staging of the cancer * scanned for bone mets when there's elevated ALP or calcium * when ALP is elevated a fractionated alkaline phosphatase test (liver versus bone) would be indicated

Answer 10

osteolytic

Answer 11

* pain may be worse at night and partially alleviated by activity. * often insidious in onset and progresses but can also be sharp, severe and radiating * A complication such as invasion of adjacent structures usually results in constant, progressively worsening pain.

Answer 12

* Sudden severe pain may be caused by a pathologic fracture and should be urgently investigated. * Pathologic fractures are more likely to occur in osteolytic as compared with osteoblastic metastases.

Answer 13

* SCLC * Hodgkin lymphoma * prostate * carcinoid

Answer 14

* renal cell * MM * melanoma * NSCLC * NHL

Answer 15

* breast cancer * GI cancers

Answer 16

* initial screen to evaluate symptomatic areas * poor sensitivity (TP rate) so generally not used to screen for bone mets

Answer 17

* detect osteolytic and osteoblastic metastases within the bone marrow * not more sensitive than a bone scan * shows associated soft tissue disease and provides 3D reconstruction of images helpful for planning RT or surgery

Answer 18

* more sensitive than CT to detect small meys * gold standard when MSCC or epidural disease/nerve root impingement is suspected because of the excellent soft tissue resolution. * It can also show the presence of spinal cord oedema. * can differentiate between pathological and insufficiency fractures

Answer 19

* sensitive to movement * ppts with implantable devices not able to undergo * severe claustophobia

Answer 20

* visualization of the entire skeleton * tracer accumulates in areas of inc osteoblastic activity * is reliable for detecting metastases in diseases like prostate and breast cancer.

Answer 21

* sensitive for malignancies like breaast, lung, prostate cancer * less sensitive for detecting tumours with little to no osteoblastic activity (such as multiple myeloma) and for aggressive lesions with rapid bone destruction

Answer 22

* analgesics - typically optiods and/ or radiotherapy * pain specialists may help relieve pain with procedures such as nerve blocks when opioid analgesics are maximized.

Answer 23

* Osteoclast inhibitors, such as bisphosphonates and denosumab - RANKL receptor inhibitor

Answer 24

- Vertebroplasty and kyphoplasty - surgeries - RT - thermal ablation - cryoablation - FUS

Answer 25

* Usually in weight bearing bones. * Associated with lytic bone metastases. * Sudden pain and loss of function.

Answer 26

* Analgesia, rest & immobilisation. * Management is mainly surgical. * Many lesions will require post operative RT.

Answer 27

* Breast * Prostate * Lung * Renal * Myeloma * Lymphoma * Melanoma

Answer 28

* pain * weakness * bowel/ bladder * sensation loss * ataxia

Answer 29

* Analgesia * dexamethasone * MRI * surgery, radiotherapy, chemotherapy

Answer 30

* inhibits cell proliferation and tumour multiplication * Affects healthy cells too

Answer 31

oestrogen receptor blockage in breast cancer

Answer 32

inhibition of androgen -> oestrogen conversion in breast cancer

Answer 33

Decrease the ovarian production of oestrogen and testicular production of testosterone - breast and prostate cancer

Answer 34

* targets Bcr-abl * in CML

Answer 35

* targets EGFR * in NSCLC

Answer 36

- Her1 and 2 receptor - Breast cancer

Answer 37

* monoclonal antibodies * cancer growth blockers * drugs that block cancer blood vessel growth * PARP inhibitors

Answer 38

The decision to use a certain anticancer drug depends on many factors, including the type and location of the cancer, its severity, whether surgery or radiation therapy can or should be used, and the side effects associated with the drug.

Answer 39

- All cytotoxic drugs except vincristine sulfate and bleomycin cause bone-marrow suppression. This commonly occurs 7 to 10 days after administration,

Answer 40

* pain * tiredness * insomnia * N & V * hair loss * bladder and bowel issues

Answer 41

* mood shifts, depression, anxiety * stress and trouble adjusting to the change in routine * chemo brain - thinking and memory problems that can happen during and after cancer treatment * frustration and anger

Answer 42

* Lethargy * Weakness * Pallor * Bruising * Bleeding * Recurrent infections.

Answer 43

* patients receiving vinca alkaloids need to be assessed for paralytic ileus which would present with constipation and absence of bowels sounds, ultra sound may be indicated. * This is a medical emergency due to the risk of perforation.

Answer 44

vincristine, vinblastine and vinorelbine)

Answer 45

* maintaining adequate fluid intake * maintaining healthy high fibre diet * gentle exercise * movicol * docusate sodium

Answer 46

* linked to 5FU and methotrexate * loperamide * coedine phosphate

Answer 47

* Nystatin suspension * fluconazole

Answer 48

* cisplatin and cyclophosphamide

Answer 49

* low risk: dexamethasone * moderate risk: 5-HT3 antagonist * high risk: dexamethsaone, 5-HT3 antagonost, NK1 antagonist e.g. aprepitant

Answer 50

* FBC * peripheral blood film * haematinics: B12 and folate * reticulocyte count * bone profile * autoimmune screen * serological tests for infections * bone marrow biopsy

Answer 51

* low neutrophil count plus * Temperature ≥ 38°C or * Other signs or symptoms consistent with significant sepsis

Answer 52

* recent chemotherapy - commonly within 7-10 days causes neutropenia through BM suppression * considered in any patient at risk of neutropenia who presents unwell, regardless of temperature bc it can present without fever in some patients including older patients and those taking immunosuppressive medications such as steroids

Answer 53

* Fatigue * Feeling warm or cold * Rigors or shaking * Feeling sweaty or clammy * Palpitations * Dizziness * Subjective confusion or disorientation

Answer 54

* Haemodynamic instability (e.g. hypotension, tachycardia, tachypnoea, hypoxia) * Fever * Reduced urine output * Altered conscious level or confusion * Mottled/ashen appearance

Answer 55

* O2 * Ab - piperacillin/tazobactam * IV fluids - 500ml of crystalloid over 15 minutes

Answer 56

* blood cultures * urine output * lactate

Answer 57

* stage 3 - important for restorative sleep * REM dreaming sleep is 90 min cycle, 25% of total sleep time

Answer 58

*Restoration and growth - Immunity to viral infection

Answer 59

*Memory Storage and Retention of memory *Organization and Reorganization - New Learning

Answer 60

1.Obstructive Sleep Apnoea 2.Central Sleep Apnoea 3. Mixed Sleep Apnoea

Answer 61

* narrow upper airway more likely to collapse than a wide upper airway * OSA patients have narrow upper airways, which can be due to fat deposition in the pharyngeal wall/tongue, or abnormal skeletal features (such as posterior positioning of the mandible). * During sleep, all muscles relax, including the pharyngeal dilator muscles. This increases the risk of upper airway collapse

Answer 62

* collapse of the upper airway can cause hypoxaemia and hypercapnia * This is detected by peripheral chemoreceptors, which stimulate the respiratory control centre in the brainstem and the sympathetic nervous system. * This leads to arousal from sleep and activation of the pharyngeal dilator muscles, resulting in airway patency. * if sleep resumes after this the upper airway can collapse again - this cycle can repeat

Answer 63

* Obesity * Craniofacial abnormalities (such as posterior positioning of the mandible) * Increased soft tissue volume (such as adenotonsillar hypertrophy) * Male sex * Down’s syndrome

Answer 64

* Excessive daytime somnolence: * Chronic morning headache: * Arousal during sleep with choking/gasping: this may be observed by the patient’s bed partner * Habitual snoring * Restless sleep

Answer 65

this can be quantified using the Epworth sleepiness scale. Patients often wake up feeling unrefreshed.

Answer 66

this could be due to hypercapnia-induced cerebral vasodilation

Answer 67

* Obesity: leads to large neck circumference * Craniofacial abnormalities (such as posterior positioning of the mandible) * Increased soft tissue volume (such as adenotonsillar hypertrophy)

Answer 68

* surgical history - tooth extractions and difficult intubations can lead to craniofacial abns * FHx of OSA * occupational history: patients with excessive sleepiness for >3 months must inform the DVLA

Answer 69

- polysomnography - resp polygraphy - overnight pulse oximetru

Answer 70

* gold standard diagnostic test for OSA * involves ppt being monitored in sleep lab overnight * monitors brain activity, muscle and respiratiry activity * OSA is diagnosed if the apnoea-hypopnoea index (number of apnoeic/hypnoeic events per hour) is ≥15 per hour, or ≥5 per hour if there are OSA symptoms/cardiovascular comorbidities.

Answer 71

* can be performed at the patients home

Answer 72

* this can also be performed at home and can demonstrate apnoeic episodes overnight.

Answer 73

* weight loss regimens * oral appliances - such as mandibular advancement devices * sleeping in the lateral position

Answer 74

* CPAP holds airway open during sleep * gold standard treatment for severe OSA

Answer 75

* Dopamine reuptake inhibitors (such as modafinil and solriamfetol) can reduce somnolence, however, these are rarely used in OSA.

Answer 76

* upper airway surgery: if CPAP and oral appliances fail * bariatic surgery

Answer 77

* CV - hypertension and MI from increases SNS activation and oxidatiev stress * diabetes: increased sympathetic nervous system activation inhibits the release of hormones that are involved in glucose metabolism * Motor vehicle accidents

Answer 78

* relief of a symptom or problem associated with an illness without curing the underlying disease process, and without attempting to prolong life

Answer 79

* encompasses patients and their families with advanced ilness * should be delivered based on need not prognosiss * can be delivered alongside disease directed therapy

Answer 80

* core aspect of care for all patients and their families with advanced diseases * includes: * holistic needs assessment and provision of basic symptom control * referral to specialist palliative care

Answer 81

process of discussion between and indiv and their care providers - facilitates and enables individuals to think abt the care that they would like to receive - allows them to choose where they want to die

Answer 82

* patient centered * prevents over-treatment when the patient lacks capacity

Answer 83

ensures best quality of care during the patients last days

Answer 84

SPICT tool - indicators of deteriation for each disease

Answer 85

- This is usually a retrosternal chest pain, that is typically relieved by sitting forward. - There may be a history of recent viral illness, or myocardial infarction (Dressler's syndrome).

Answer 86

adenosine related dysponea

Answer 87

* avoid high intensity exercise on statins due to increased risk of muscle breakdown secondary to rhabdomyolysis.

Answer 88

bradycardia, dizziness and syncope

Answer 89

arrhythmias, diarrhoea and skin reactions

Answer 90

dizziness, electrolyte imbalance and muscle spasms

Answer 91

aorta passing thru diagphragm

Answer 92

* Intra cerebral pressure is governed by Monroe-Kelly Doctrine which considers brain as closed box, changes in pressure are offset by loss of CSF. When this is no longer possible ICP rises

Answer 93

* Aortic regurgitation produces an early diastolic, high-pitched, blowing murmur, which is louder on sitting forward and at the left sternal edge.

Answer 94

collapsing

Answer 95

- visible pulsing red colouration of the nails - AR

Answer 96

* Aortic stenosis does not cause a diastolic murmur or collapsing pulse. Aortic stenosis more commonly produces an ejection systolic murmur which is louder on expiration.

Answer 97

Slow rising (collapsing in AR)

Answer 98

radial artery - commonly injured by a scaphoid bone fracture

Answer 99

Amiodarone

Answer 100

reversible direct thrombin inhibitor

Answer 101

posterior cerebral artery and cerebellar arteries (which arise from the basilar and vertebral arteries) respectively.

Answer 102

* Ranolazine inhibits persistent or late sodium current in heart muscle in various voltage-gated sodium channels. * This leads to reduced intracellular calcium levels, which subsequently reduces the tension in the heart muscle, lowering its oxygen demand.

Answer 103

sinus tachy

Answer 104

- Beck's triad': hypotension, a raised JVP and muffled heart sounds. - It may associated with dyspnoea. and tachycardia.

Answer 105

tricuspid valve. All valves in the heart are derived from the endocardial cushion.

Answer 106

= (stroke volume / end diastolic LV volume ) * 100%

Answer 107

end diastolic volume - systolic volume

Answer 108

IVC opening in diaphragm

Answer 109

Oesophagus opening in diaphragm - Oesophagus has 10 letters

Answer 110

Coeliac trunk

Answer 111

Internal Iliac artery

Answer 112

1972 - 10, 9, 7, 2 0 - these are affected by warfarin

Answer 113

Paracetamol overdose

Answer 114

In chronic disease prevalence is greater than incidence - in acute disease the incidence is greater than the prevalence

Answer 115

- tall stature, pectus excavatum and joint hypermobility - RF for aortic dissection

Answer 116

widened mediastinum

Answer 117

Transoesophageal echocardiography (TOE) is more suitable for patients with suspected aortic dissection who are unstable and therefore too risky to take to the CT scanner.

Answer 118

dyspnoea, orthopnoea, and paroxysmal nocturnal dyspnoea.

Answer 119

rheumatic fever

Answer 120

wide pulse pressure (114mg) and nail-bed pulsation (Quincke's sign).

Answer 121

early diastolic

Answer 122

heard with patent ductus arteriosus.

Answer 123

heard with aortic stenosis, pulmonary stenosis, atrial septal defects, tetralogy of Fallot, and hypertrophic obstructive cardiomyopathy.

Answer 124

heard with mitral valve prolapse and coarctation of the aorta.

Answer 125

mitral regurgitation, tricuspid regurgitation, or ventricular septal defect.

Answer 126

mitral stenosis

Answer 127

* small or absent T waves (occasionally inversion) * prolong PR interval * ST depression * long QT * U waves

Answer 128

MR ASS mitral regurg, aortic stenosis (systolic murmurs)

Answer 129

aortic regurg, mitral stenosis (diastolic murmurs)

Answer 130

In the context of a tachyarrhythmia, a systolic BP < 90 mmHg → DC cardioversion

Answer 131

right coronary artery lesion

Answer 132

Nitrates are contraindicated in patients with hypotension (< 90 mmHg)

Answer 133

Widespread joint hypermobility along with skin changes indicated by striae should make you think of a collagen disorder - these findings are commonly present in Ehlers-Danlos syndrome.

Answer 134

Mitral valve prolapse and mitral regurgitation are associated with Marfan's and Ehlers-Danlos syndromes. Mitral regurgitation would produce a pansystolic murmur

Answer 135

hypokalaemia, hypomagnesemia and hypocalcaemia

Answer 136

- Pulmonary embolism and renal impairment → V/Q scan is the investigation of choice - - CTPA when no renal impairment bc CTPA can cause renal damage

Answer 137

lAD lesion

Answer 138

RCA lesion

Answer 139

Patients with bradycardia and signs of shock require 500micrograms of atropine (repeated up to max 3mg) - cardioversion is not used for bradycardias but pacing can be used

Answer 140

- It usually presents with abrupt, severe pain; and is often described as sharp, as opposed to tight/crushing pain experienced in myocardial infarction. - Hypertension and aortic valve pathologies are also risk factors for aortic dissection. - Patients often present with acute hypotension, due to aortic regurgitation or cardiac tamponade.

Answer 141

- neurological changes

Answer 142

- Focal neurological deficits occur due to propagation of the intimal tear to branch arteries, or due to mass effects as the expanding aorta compresses surrounding structures. - can be with symptoms of Horner's syndrome (classically ptosis, miosis and anhidrosis) due to compression of the sympathetic trunk by the expanding aortic dissection.

Answer 143

PR depression

Answer 144

Verapamil and beta-blockers should never be taken concurrently - possibility of heart block and fatal arrest

Answer 145

acute mitral regurgitation → widespread systolic murmur, hypotension, pulmonary oedema

Answer 146

- HTN with Diabetes without renal vascular disease: rampiril - diabetes w renal vascular disease: amlodepine - ACE/ARB CI

Answer 147

- electrolyte disturbances such as hypokalemia, hyponatremia, and hypomagnesemia - Also hypocalcaemia -> osteoporosis - e.g bumetanide

Answer 148

Hypocalcaemia, hypokalemia, hypomagnesaemia, hypothermia

Answer 149

dissection

Answer 150

urgent investigations for end-organ damage

Answer 151

- angioedema - characterised by marked tongue and facial swelling - can occur at any time during treatment, even weeks or months after initiation.

Answer 152

* previous diagnosis of asthma or atopy * a higher blood eosinophil count * substantial variation in FEV1 over time (at least 400 ml) * substantial diurnal variation in peak expiratory flow (at least 20%)

Answer 153

alpha-1 antitrypsin

Answer 154

Klebsiella most commonly causes a cavitating pneumonia in the upper lobes, mainly in diabetics and alcoholics

Answer 155

sudden cardiac death in young atheles, common cause of sudden death - ventricular arrythmias

Answer 156

Usually due to a mutation in the gene encoding β-myosin heavy chain protein

Answer 157

- epsilon wave - terminal notch in QRS - ECG abnormalities in V1-3, typically T wave inversion

Answer 158

- right V myocardium replaced by fatty tossie

Answer 159

- alc - coxsackie B - doxorubicin

Answer 160

- amyloidosis - post radiotherapy

Answer 161

- stress induced - transient apical ballooning of myocardium

Answer 162

chagas disease, coxsackie B virus

Answer 163

doxorubicin, alcoholic cardiomyopathy

Answer 164

- externtional dyspnoea - most cpmmon - angina - syncope - palpitations - HF

Answer 165

- Harsh ejection systolic - heard best at left lower sternal border - typically increases with Valsalva manoeuvre and decreases with squatting or handgrip.

Answer 166

Bifid carotid pulse: A rapid upstroke followed by a mid-systolic dip may be observed, known as the 'spike and dome' pulse

Answer 167

- most common cardiomyopathy - mostly idopathic

Answer 168

- dilated heart leading to predominately systolic dysfunction - all 4 chambers are dilated, but the left ventricle more so than right ventricle - eccentric hypertrophy (sarcomeres added in series) is seen

Answer 169

- Classical features of HF - systolic murmurs - mitral and tricuspid regurg - S3 - balloon app of heart on CXR

Answer 170

- Grade 1: very quiet, heard by experts - Grade 2: slight murmur, should be heard by most examiners - Grade 3: moderate, easily heard, no palpable thrill - Grade 4: loud, palpable thrill - Grade 5: very loud, palpable thrill - Grade 6: can be heard without a stethoscope - It is very rare for a diastolic murmur to be grade 5 or above and as such, they are typically graded 1-4 ***Levine Scale***.

Answer 171

- ejection systolic - best heard at the lower left sternal edge - best heard at the apex and may radiate to the axilla

Answer 172

- IE - degenerative - Rheumatic heart disease

Answer 173

- Rapid development of HF, flash pulm oedema

Answer 174

- Dyspnoea, orthopnea

Answer 175

- Soft S1 - S3 - mid-systolic click

Answer 176

- Rheumatic hd - Carcinoid syndrome = IE

Answer 177

- Pulm HTN - dilation of RV

Answer 178

- Prominent, pulsatile JVP - Large cv wave in JVP - S3/S4 - Liver may be enlarged and pulsatile

Answer 179

aortic area and left sternal edge

Answer 180

- lower left sternal edge - apex

Answer 181

lower left sternal edge

Answer 182

left sternal edge

Answer 183

AS, PS, HCOM

Answer 184

- trisucpid regurg - mitral regurg - VSD

Answer 185

- Mitral: accenuated on exp: ME - Trucspid: inspiration TIME

Answer 186

- IE - arotic dissection - acute rheumatic fever

Answer 187

- Rheumatic HD - biscispid aortic valve

Answer 188

aortic regurg

Answer 189

Mitral stenosis

Answer 190

- Mitral facies - Pulm HTN - RHF

Answer 191

- Raised JVP - Peripheral oedema - Hepatomegaly

Answer 192

- aortic regurg - pulm regurg - these are decresndo murmurs

Answer 193

- MS - tricisid stenosis

Answer 194

- heard in the left sternal edge, 4th ics - Exp, leaning forward

Answer 195

- pulm area - inspiration

Answer 196

- expiration, lying on left side - apex

Answer 197

- insp - keft sternal edge

Answer 198

Myocarditis presents with ST elevation and acute pulmonary oedema in a young patient with a recent flu-like illness

Answer 199

* 1st line: CT coronary angiography * 2nd line: non-invasive functional imaging (looking for reversible myocardial ischaemia) * 3rd line: invasive coronary angiography

Answer 200

- myocardial perfusion scintigraphy with single photon emission computed tomography (MPS with SPECT) or stress echocardiography or - first-pass contrast-enhanced magnetic resonance (MR) perfusion or MR imaging for stress-induced wall motion abnormalities

Answer 201

- Broad complex tachycardia following a myocardial infarction is almost always due to ventricular tachycardia.

Block 31 Week 8 Flashcards

(244 cards)