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What is the key pathological feature of acute rheumatic heart disease?
Aschoff body (focal inflammatory lesions, small sterile vegetations)
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What is the skin rash in rheumatic fever?
Erythema marginatum and skin nodules
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What does acute rheumatic fever follow?
Sore throat: group A strep – antibody cross-reactivity
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After an MI and low BP, what is most common cause of acute renal failure?
Acute tubular necrosis
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Which conditions is rosiglitazone CI in?
CCF (fluid retention), hepatic dysfunction
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Which conditions can you not use sulphonylurea in?
Renal failure
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When should metformin be stopped?
In organ FAILURES eg heart, liver, kidney, resp
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What are the ECG signs of hypercalcaemia?
QT interval shortening
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What happens to the intensity and the length of the murmur in AS with time?
- Intensity decreases as less CO with disease
- Length increases: as disease becomes more severe, longer ejection time is needed
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What are the signs, symptoms and ECG signs of digoxin toxicity?
- Nausea
- Fatigue
- ECG: reverse tick sign on ST segment, Heart block
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Which congenital heart disease is associated with wide fixed split second heart sound?
ASD
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Which type of murmur is assciated with ASD?
- Pulmonary ejection systolic murmur
- Also PR or TR due to pulmonary hypertension
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What are the 2 complications of ASD?
- Eisenmenger’s syndrome (L to R then pulm HTN then R to L – cyanosis!)
- Paradoxical embolism
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Which type of MI will furosemide make the situation worse in? and what is the ideal treatment? And monitor?
- Right ventricular MI
- Treat: give fluid to increase the LVEDP
- Monitor: PCWP
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When does fallots tetralogy present?
- After 3 months of life
- It is the most common congenital cyanotic heart disease
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when do you get reverse splitting of 2nd HS and what does this mean?
- P2 before A2
- LBBB
- aortic stenosis
- PDA
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when do you get wide fixed splitting of 2nd HS?
ASD
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when do you get wide splitting of 2nd HS?
- RBBB
- pulmonary stenosis
- mitral regurg
- VSD
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what is the cause of 3rd HS and what age is it pathological?
- pathological over 30
- cause: dilated LV with rapid ventricular filling (mitral regurg, VSD)
- or poor LV function (post MI, DCM)
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what causes a 4th HS?
atrial contraction against a stiff ventricle due to aortic stenosis or hypertensive heart disease
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what is it called when there is an ESM over aortic area but not radiation to carotids?
aortic sclerosis
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when do you get gallop rhythms?
3rd or 4th HS occuring in sinus tachycardia
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