1
Q
What to give patients on Warfarin that need to undergoe emergency surgery?
A
give four-factor prothrombin complex concentrate
2
Q
When is it best to take Statins?
A
At night
3
Q
What is Primary prevention for statin?
A
20 mg Atrovastatin
10 % QRISK
4
Q
What is Secondary Prevention for statin?
A
past ischaemic disease
Atrovastatin 80mg
5
Q
With which other medication should Statins be stopped?
A
Macrolides
Pregnancy
6
Q
What blood tests for Statins?
A
LFT’s before administering, 3 months and 12 months after
7
Q
What is the management of Tachycardia with hypotension?
A
Immediate Cardioversion
8
Q
What is the Management of Narrow Complex Tachycardia?
A
- vagal manoeuvres: Valsalva manoeuvre: e.g. trying to blow into an empty plastic syringe OR
carotid sinus massage (should only be unilateral) - intravenous adenosine: rapid IV bolus of 6mg → if unsuccessful give 12 mg → if unsuccessful give further 18 mg
contraindicated in asthmatics - verapamil is a preferable option, can experience flushing
- electrical cardioversion
9
Q
How to prevent future episodes of Tachycardia?
A
- beta-blockers
- radio-frequency ablation
10
Q
How to manage Broad Complex Tachycardia?
A
Amiodarine 30mg IV over 10-60 min
11
Q
What is one clue that ensures the patient is not in Ventricular Fibrillation?
A
if Patient is awake
12
Q
What is the management of Ventricular Tachycardia?
A
- amiodarone: ideally administered through a central line
- lidocaine: use with caution in severe left ventricular impairment
- procainamide
if the patient has adverse signs (systolic BP < 90 mmHg, chest pain, heart failure) then immediate cardioversion is indicated, you do CTI ablation
13
Q
Which medication is contraindicated in Ventricular Tachycardia ?
A
Verapamil
14
Q
What are two common causes of Torsades de Pointes?
A
Macrolides
Hypothermia
15
Q
What is the treatment for Torsades de Pointes?
A
IV magnesium Sulphate
16
Q
J-wave on ECG
A
HYPOTHERMIA
17
Q
How do you manage patient with suspicion of PE?
A
Well’s score: if more then 4 points then likely
If a PE is ‘likely’ (more than 4 points)
* arrange an immediate computed tomography pulmonary angiogram (CTPA) (provide with DOAC if there is a delay)
if the CTPA is negative then consider a proximal leg vein ultrasound scan if DVT is suspected
If a PE is ‘unlikely’ (4 points or less)
- arranged a D-dimer test
o if positive arrange an immediate computed tomography pulmonary angiogram (CTPA). (provide with DOAC if there is a delay)
18
Q
wedge-shaped opacification on CXR
A
PE
19
Q
Which score can be used to see if a patient with PE can be managed as an outpatient?
A
Pulmonary Embolism Severity Index (PESI)
20
Q
Management of PE with renal impairment
A
LMWH
21
Q
PE management with anti-phospholipid syndrome
A
LMWH followed by a VKA
22
Q
What is the management of PE
A
DOAC
(except if anti-phospholipid syndrome, active cancer or bad renal funciton)
23
Q
Management of PE with hypotention
A
Thrombolysis
24
Q
Management of reacurrent PE
A
consider inferior vena cava (IVC) filters
25
Aschoff bodies
Rheumatic FEVER
26
Pathophysiology of Rheumatic Fever
immunological reaction to a recent (2-4 weeks ago) Streptococcus pyogenes infection.
Type 2 hypersensitivity reaction
27
What are the diagnostic Criteria for Infective Endocarditis?
JONES criteria:
J-joints
O-heart- ejection systolic murmur
N-nodules
E-erythema marginatum
S- Sydenham’s chorea
28
What is the management of Rheumatic Fever?
antibiotics: **oral penicillin V**
anti-inflammatories: NSAIDs are first-line
treatment of any complications that develop e.g. heart failure
29
What SE of MI occurs in the first 2 weeks with raised JVP, pulsus paradoxus
Left ventricular free wall rupture
30
What SE of MI presents in first week with , acute heart failure with pan-systolic murmur
Ventricular septal defect
31
What SE of MI presents with acute mitral regurgitation → widespread systolic murmur, hypotension, pulmonary oedema
Rupture of the papillary muscle
32
How to manage Left ventricular free wall rupture
Urgent pericardiocentesis and thoracotomy
33
When should Adenosine be avoided?
Asthmatic Patients
give Verapamil
34
How should Adenosine be delivered?
Should be given through a large calibre cannula (16G) due to the short half life
35
What is the most common SE of ACE-inhibitor?
Cough
36
Can ACE-inhibitors be given in pregnancy and breastfeeding?
Nope
37
What tests before starting Amiodarine?
TFT, LFT, U&E, CXR prior to treatment
38
What is a common SE of Nicorandil, potassium channel activator
gastrointestinal ulcers and anal ulceration
39
What is anti-coagulation of choice for Mitral Stenosis?
Warfarin
40
What is the best modality to investigate Takayasu's arteritis?
MRA or CT angiography (vascular imaging)
41
How do you manage Takayasu's arteritis?
Steroid
42
Patient presents with malaise, peripheral weak pulses, carotid bruit, unequal blood pressure on both limbs
asian yound
Takayasu's arteritis
43
What is the management of Necrotising Fasciitis?
* urgent surgical referral debridement
* intravenous antibiotics
44
What is a normal ABPI?
0.9 - 1.2. Values below 0.9 indicate arterial disease
45
What is the characteristic location of a venous ulcer?
above the ankle, painless
46
Ulcer that appears oedomatous, brown colored and lipodermatosclerosis
Venous Ulceration
47
What is the best investigation for Venous Ulcer?
Doppler ultrasound
48
What is the management for Venous Ulcers?
**compression bandaging**, usually four layer (only treatment shown to be of real benefit)
**oral pentoxifylline**, a peripheral vasodilator, improves healing rate
49
Ulcer on a pale pulsless limb
Arterial Ulcers
50
What is the typical appearance of an Arterial Ulcer?
a 'deep, punched-out' appearance
painfull
51
What is the common location for an Arterial Ulcer ?
toes and heel
52
What is the reverse Agent for Apixaban/Rivaroxaban?
Andexalet Alpha
53
What is the reversal agent for Dabigatran?
Idarucimab
54
What is the reversal Agent for Warfarin?
Vit K (Phytomenodione)
55
What is the reversal agent for Heparine?
Protamine
56
Angioplasty and DVLA
1 WEEK
57
ACS and DVLA
4 weeks off driving (if lorry driver then 6 weeks)
1 week if successfully treated by angioplasty
no need to inform DVLA
58
Pacemaker and DVLA
1 WEEK OFF DRIVING
59
Heart Transplant and DVLA
6 WEEKS OFF DRIVING
60
What anti-platelet medication after ACS?
Aspirin (lifelong) & ticagrelor (12 months)
61
What anti-platelet medication after Percutaneous coronary intervention?
Aspirin (lifelong) & prasurgrel or ticagrelor (12 months)
62
What anti-platelet medication after TIA
Clopidogrel 75mg (lifelong)
63
What anti-platelet medication after Ischaemic Stroke?
75mg Clopidogrel (lifelong) (Aspirin 300mg for 2 weeks)
64
What anti-platelet medication after Peripheral Artery Disease?
Clopidogrel (lifelong)
65
Patient presents with dizziness and vertigo, during exertion of an arm.
Subclavian Steal Syndrome
66
Which coronary artery affects V1-V4 leads?
Left anterior descending
67
Which coronary artery affects II, III, aVF leads?
Righ Coronary
68
Which coronary Artery affects V1-6, I, aVL?
Proximal left anterior descending
69
Which coronary artery affects leads: I, aVL +/- V5-6?
Left Circumflex
70
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Which coronary artery affects Changes in V1-3 leads?
left anterior descending
71
Ratio of Chest Compression in ALS?
30:2
72
How many shocks can be given in ALS?
o a single shock for VF/pulseless VT followed by 2 minutes of CPR
o if the patient is being monitored then give three consecutive shocks
73
What access for medication is prefered for ALS?
IV access should be attempted and is first-line
Second line intraosseous route (IO) (tracheal route is not recommended)
74
How to administer Adrenaline in ALS?
Adrenaline 1 mg as soon as possible for non-shockable rhythms (pulseless)
During a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
Repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
75
When do you give Amiodarone in ALS?
amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
a further dose of amiodarone 150 mg should be given to patients who ar in VF/pulseless VT after 5 shocks have been administered
76
What else can you give instead of Amiodarone in ALS?
LIDOCAINE
77
What should you do in case of HYPOTHERMIA in ALS?
Defibrillation is less effective and only 3 shocks should be administered before the patient is rewarmed to 30 degrees centigrade
78
Summarize ALS
Chest compressions
o the ratio of chest compressions to ventilation is 30:2
Defibrillation
o a single shock for VF/pulseless VT followed by 2 minutes of CPR
o if the patient is being monitored then give three consecutive shocks
Drug delivery
o IV access should be attempted and is first-line
o Second line intraosseous route (IO) (tracheal route is not recommended)
Adrenaline
o adrenaline 1 mg as soon as possible for non-shockable rhythms (pulseless)
o during a VF/VT cardiac arrest, adrenaline 1 mg is given once chest compressions have restarted after the third shock
o repeat adrenaline 1mg every 3-5 minutes whilst ALS continues
Amiodarone (lidocaine if not available)
o amiodarone 300 mg should be given to patients who are in VF/pulseless VT after 3 shocks have been administered.
o a further dose of amiodarone 150 mg should be given to patients who ar in VF/pulseless VT after 5 shocks have been administered
Thrombolytic drugs
o should be considered if a pulmonary embolus is suspected- ALTEPLASE
o if given, CPR should be continued for an extended period of 60-90 minutes
79
Holosystolic murm blowing in character
tricuspid regurgitation
80
Pulmonary embolism and renal impairment what mode of investigation
V/Q scan is the investigation of choice
81
How should symptomatic vs Asymptomatic mitral stenosis be managed?
asymptomatic patients
**should be monitored** with regular echocardiograms
percutaneous/surgical management is generally not recommended
symptomatic patients
percutaneous mitral balloon valvotomy
mitral valve surgery (commissurotomy, or valve replacement)
82
Which enzyme to look for re-infraction?
CK-MB is useful to look for reinfarction as it returns to normal after 2-3 days (troponin T remains elevated for up to 10 days)
83
WHAT are the SE of loop diuretics
Loop Diuretics: Furosemide and bumetanide
Hypotension
Hyponatraemia, hypokalaemia, hypocalcaemia
Ototoxicity
renal impairment
Hyperglycaemia
84
what is the screening for AAA
Screening for an abdominal aortic aneurysm consists of a single abdominal ultrasound for males aged 65.
85
Systolic = ASMR (Aortic stenosis, mitral regurg)
Diastolic = ARMS (aortic regurg, mitral stenosis)
86
what is the management for peripheral artery disease
Atorvastatin 80 mg
clopidogrel
87
what to give a HTN pt black and with DM
n black African and Afro-Caribbean patients, A2RBs are preferred over ACE inhibitors.
iRBESARTAN
88
what monitoring is required for LMWH and unfractioned heparin
Unlike low molecular weight heparins that do not require monitoring unfractionated heparin does require monitoring, this is done by measuring the APTT.
89
which beta blockers have reduced mortality in stable HF
Both carvedilol and bisoprolol have been shown to reduce mortality in stable heart failure
90
what electrolyte abnormality leads to prolonged QT syndrome
Hypokalaemia, think loop diuretics
91
Which artery will result in MI and Bradycardia ?
A right coronary infarct supplies the AV node so can cause arrhythmias after infarction
92
When is a patient predisposed to digoxin toxicity
Digoxin toxicity is more likely to occur in the presence of **hypokalaemia**. This is because digoxin and potassium compete for binding sites on the Na+/K+ ATPase pump, which is inhibited by digoxin as part of its mechanism of action. When potassium levels are low, there is less competition for these binding sites, allowing more digoxin to bind and exert its effects, thus increasing the risk of toxicity.
93
How to chose between bioprosthetic and mechanical valve?
Bioprosthetic valves have the advantage of not requiring long-term anticoagulation, unlike mechanical valves, and are generally preferred in older patients due to their better hemodynamic properties and lower risk of thromboembolic complications.
94
What electrolyte abnormalities can cause long QT syndrome/
hypokalaemia, hypocalcaemia and hypomagnesaemia
95
What is the mode of action of Aspirin?
non reversible COX 1 and 2 inhibitor
Year-6
flashcards
Decks in class (34)
# Cards
-
Gastroenterology vol1115
-
Gastroenterology vol2119
-
Rheumatology 170
-
Rheumatology COPY66
-
Orthopaedics74
-
Respiratory 180
-
Respiratory 2101
-
Cardiovascular116
-
Cardiovascular II95
-
Vascular + ENT126
-
NEUROLOGY 1110
-
NEUROLOGY 2104
-
Renal66
-
Renal COPY66
-
Urology98
-
Infectious Diseases 1107
-
Infectious Diseases 2109
-
Endocrinology149
-
Haematology99
-
Psychiatry44
-
Dermatology64
-
Dermatology vol 239
-
Obstetrics85
-
Contraceptive26
-
Breast16
-
Opthalmoscopy72
-
Geriatrics18
-
Palliative Care8
-
Anaesthesia29
-
Oncology24
-
Felicia70
-
sHAkIrA58
-
PSA25
-
Fluids6
