Progress 8 (Page 100-

mbch4kz2's version from 2016-05-08 18:46


Question Answer
What investigations would you order for someone with suspected COPD)1. Postbronchodilator spirometry 2. CXR (hyperinflation, bullae, flat hemidiaphragm- also need to exclude cancer) 3. FBC (exclude secondary polycythaemia)
What FEV1 is mild COPD?>80%
What FEV1 is moderate COPD?50-79%
What FEV1 is severe COPD?30-49%
What FEV1 is very severe COPD?<30%
What is the treatment of someone on warfarin who is excessively bleeding?1. Stop warfarin 2. Give IV vitamin K (5mg) 3. Prothrombin complex concentrate (if not available then FFP)
What is the treatment of someone who is minorly bleeding (INR >8)?1. Stop warfarin 2. Five IV vitmain K (3mg) 3. Restart warfarin when INR <5
When would prothrombin complexes be considered as opposed to FFP in cases of bleeding?FFP can take time to defrost, in cases of intracranial haemorrhage prothrombin complex concentrates should be considered
What are the pathological criteria for infective endocarditis?Valve tissue, vegetations, embolic fragments, intracardiac abscesses
What prophylaxis should be given for infective endocarditis?1. Vancomycin + Ceftriaxone 2. Gentamcin + Vancomycin 3. Cefepime
What is the ratio of chest compressions to ventilation in advanced life support?30:2
What should be given and how often in a patient with systole with chest compressions in ALS?Adrenaline 1mg given once after 3rd shock and then every 3-5 minutes. Amiodarone should also be given after 3rd shock
What are shockable rhythms?VF and pulseless VT
What is the treatment of torsades de pointes?IV magnesium sulphate
When would you not give a B-blocker in a patient with AF?If patient has asthma (use a rate-limiting Ca-channel blocker; Diltiazem)
What is hypetrophic obstructive cardiomyopathy?Autosomal dominant disorder of muscle tissue caused by defects in the genes encoding contractile proteins- most common defects involve a mutation in the gene encoding B-myosin heavy chain protein
What are the features of HOCM?1. Often asymptomatic 2. Dyspnoea, angina, syncope 3. Sudden death (most commonly due to ventricular arrhythmias) 4. Heart failure 5. Jerky pulses (a waves) 6. Double apex beat 7. Ejection systolic murmur (increases with valsalva manoeuvre and decreases on equating)
What features would you see on an ECG with someone with HOCM?1. Left ventricular hypertrophy 2. Progressive T wave inversion 3. Deep Q waves 4. AF may occasionally be seen
What features of HOCM are often evident (MR SAM ASH)?Mitral regurgitation, systolic anterior motion of anterior mitral valve leaflet and asymmetric hypertrophy
What are the commonest causative organisms for community acquired pneumonia?Streptococcus pneumoniae and haemophilus influenzae
What are the typical symptoms you see in mycoplasma pneumonia?1. Abdominal pain 2. Dry cough 3. Hyponatraemia 4. Erythema multiforme 5. Hyponatraemia - Typically occurs in young people, insidious onset with flu-like symptoms and atypical features
What is the treatment for mycoplasma pneumonia infection?Clarithromycin or tetracycline or fluoroquionolone
When would pneumocystis jiroveci be present?Seen in immunocompromised patients- presents with exertional breathlessness (patients are seen to desaturate while walking). HIV should be considered in the diagnostic work up

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