Progress 4 (Page 44-60)

mbch4kz2's version from 2016-05-07 17:32


Question Answer
What causes the 1st heart sound, what causes it to be soft or loud?Mitral and tricuspid valves closing. Loud- Mitral stenosis Soft- Liong PR or mitral regurgitation
What causes the 2nd heart sound, what causes it to be soft?Aortic and pulmonary valves closing. Soft- Aortic stenosis
What causes a 3rd heart sound?Diastolic filling of the ventricles- normal if <30. May persist in women >50. May occur in left ventricular failure (eg. dilated cardiomyopathy or constrictive pericarditis- pericardial knock)
What causes a 4th heart sound?Aortic stenosis, HOCM, hypertension, atria contracting against a stiff ventricle
What is von Willebrand's diseaseAutosomal dominant bleeding condition (most common)- most are mild-mucosal membrane injuries. Due to a structural abnormality of Von Willebrand's factor (dual role of promoting normal platelet function and stabilising coagulation factor VII)
What is the treatment of vW disease?Patient with mild disease respond to desmopressin. Clotting factor concentrates are needed for a minority
What is the role of von Willebrand's factor?A large glycoprotein that promotes platelet adhesion to damaged endothelium. It is a carrier molecule for factor VIII.
What are the 3 types of vonWillebrand's disease?Type 1: Partial reduction in vWF (80%) Type II: Abnormal form of vWF Type III: Total lack of vWF (autosomal recessive)
What investigations should you do for vW disease?Prolonged bleeding time, APTT may be prolonged, Factor VIII levels may be moderately decreased, defective platelet aggregation with ristocetin
Name 5 factors that make a diagnosis of asthma more likely?Wheeze, SOB, chest tightness, cough, history of atopic disorder, family history, unexplained decrease in FEV1 or unexplained peripheral blood eosinophilia, symptoms worse at night and early morning, respond to exercise, allergies, cold, symptoms after taking aspirin or B-blocker
What FEV1/FVC ration suggests asthma <0.7
What requirements are necessary in order to discharge a patient with asthma?Minimum 12 hours for a patient to be off nebulisers, PEFR >70%, smoking cessation advice, written asthma action plan, review inhaler technique and compliance, explore triggers, flu vaccine, pneumococcal
What is the treatment for supra ventricular tachycardia?Vagal manœuvres- if this fails then IV adenosine (6-12mg; contraindicated in asthma- use verapamil). Episodes are characterised by the sudden onset of a narrow complex tachycardia
What are the defining points of bundle branch block?1. Broad QRS (>120ms) 2. RSR pattern in V1-3 (M shaped QRS) 3. Wide, slurred S waves in lateral leads- aVL, V5-6
Name 3 causes of RBBBNormal with age, RV hypertrophy, chronically increased RV pressure (eg. cor pulmonale), PE, MI, atrial septal defect, cardiomyopathy or myocarditis
What is sickle cell crisis- aplasticA sudden fall in Hb without appropriate reticulocytosis is typical of an aplastic crisis- usually secondary to parovirus infection. Sickle cell anaemia is characterised by periods of good health with intervening crises
What are the 4 main types of sickle cell crises1. Thombotic 'painful crises' 2. Sequestation 3. Aplastic 4. Haemolytic
What are the features of a thrombotic sickle-cell crisesPainful- vaso-occlusive. Precipitated by infection, dehydration, de-oxygenation. Infarcts occur in various organs (including bones)- eg. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain
What are the features of a sequestration crises?Sickling within organs such as the spleen or lungs cause pooling of blood with worsening of the anaemia. Acute chest syndrome - Dyspnoea, chest pain, pulmonary infiltrates, low pO2 - most common cause of death after childhood
What are the features of a haemolytic crises?Rare, fall in Hb due to an increased rate of haemolysis