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LEFT sided heart failure is commonly caused by
Ischaemic heart disease
-
Ischaemic heart disease irreversible risk factors are:
-
Ischaemic heart disease reversible risk factors are:
- Hyperlipidaemia
- Smoking
- Hypertension
- Hyperhomocystinaemia
- Diabetes
-
As well as ischaemic heart disease, what are the other causes of LEFT sided heart failure
- Systemic hypertension
- Aortic valve disease
- Mitral valve disease
-
Pulmonary congestion will present with
- Orthopnoea - DIB when lying flat
- Paroxysmal Nocturnal Dyspnoea - Waking up suddenly DIB
- Fatigue
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When carrying out a cardio exam you notice increase breathing pattern, increase pulse, basal lung crackles, pain in chest
You should suspect LEFT sided heart failure
-
Most frequent cause of RIGHT sided heart failure is
LEFT sided heart failure is normally primary and RIGHT is secondary
-
A patient presents with pain in the RUQ, jugular vein distension or pitting oedema what should be suspected
RIGHT sided heart failure
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Biventricular heart failure is also known as
Congestive heart failure
-
Combination of LEFT and RIGHT sided heart failure can be described as
Congestive heart failure
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What 7 clinical presentations are there with suspected heart failure
- Orthopnoea - DIB when lying flat
- Paroxysmal Nocturnal Dyspnoea - Waking up suddenly DIB
- Fatigue
- RUQ pain
- Jugular vein distension
- Pitting oedema
- Chest pain
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2 types of LEFT sided heart failure are
- Systolic - Left ventricle loses ability to PUMP
- Diastolic - Left ventricle loses ability to RELAX
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When the left ventricle fails to accept blood and there is a build up of fluid and backwash into the lungs, ultimately damaging the right side
RIGHT sided heart failure
-
Differences between LEFT and RIGHT sided heart failure
- Left affects the LUNGS= DIB
- RIGHT affects the BODY = Oedema
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Mean age in HYPOthyroidism & HYPERthyroidism varies
-
HYPO is to Hashimotos, as HYPER is to
Graves
-
HYPER is to Graves as HYPO is to
Hashimotos
-
Levothyroxine is treatment for
Hypothyroidism
-
Thyroxine is treatment for
Hypertyroidism
-
High levels of T3 & T4 will cause
Hypethyroidism
-
Low levels of T3 & T4
Hyporthyroidism
-
List 11 clinical presentations of HYPOTHYROIDISM (MOMS SO TIRED)
- Memory Loss
- Obesity
- Malar Flush/menorrhagia
- Slowness
- Skin & Hair become dry
- Onset is gradual
- Tired
- Intolerance to cold
- Raised blood pressure
- Energy levels are low
- Depressed
-
List 8 clinical presentations of HYPERTHYROIDISM (SWEATING)
- Sweating
- Weight loss
- Emotional instability
- Appetite increased
- Tremor/Tachycardi
- Irregular periods
- Nervousness
- Goitre
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There is a HLA and genetic link in Ulcerative Colitis, what are the 2 types of UC
- Rectum = Proctitis
- Colon = Pancolitis
-
9 features of Ulcerative Collitis
- ULCERS IN A
- Ulcers (mucosal and sub)
- Large intestine
- Clubbing
- Extra-intestinal manifestations
- Remnants of old ulcers
- Stools are bloody
- Inflamed, red, granular mucosa and sub
- Neutrophil invasion
- Abscesses in crypts
-
5 Complications of Ulcerative Collitis
- Perforation
- Gall stones
- Colorectal cancer
- Haemorrage
- Toxic megacolon
-
10 common factors of UC and Crohns
- Abdominal distension
- Diarrhoea with blood
- Aneamia
- Clubbing
- Fever
- Malaise
- Sacrolitis
- Conjunctivits
- Large joint arthralgia
- Oral Ulcers
-
Differences between UC and Crohns
- UC - Large Bowel only, Unaffected by diet, Tachycardia, urgency to pass stools and pain around periumbiliical with radiation into lower back - Blockage
- Crohns - Anywhere in GIT, related to high sugar and fibre, No tachycardia, relief on passing stools and increase in stool turnover and occasional right iliac fossa pain.
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3 Basic stages of Rheumatoid Arthritis are:
- Synovitis - Oedema and chronic inflammation of synovium
- Destruction - Persistent inflammation causes tissue obstruction and articular cartilage is eroded, tendon fibres may rupture
- Deformity - Follows repeated attacks on a joint causing hypermobility
-
What happens in the SYNOVITIS stage of Rheumatoid Arthritis
- Hyperplasia of synovial cells produce a thickening of the membrane
- Synovial tissue expands by proliferation of capillaries, lymphocytes, macrophages and plasma cells
- Synovium appears dense
- Joint become swollen, warm and stiff = Decreased ROM
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What happens in the DESTRUCTION phase of Rheumatoid Arthritis
- MRI's indicate the folwing in 3 - 6/12 after onset
- Fibroblasts proliferate and deposit collagen fibres
- Synovial surface becomes spotted with fibrin
- Fibrin coat sticks to the periphery of articular surfaces forming Pannus
- Inflammatory cells pass through the folds and fronds into synovial fluid
- Pannus coats articular surface
- Chondrocytes and Cytokines damage the cartilage
- Cartiliage becomes thin and bone is exposed
- Subchondral bone erodes at joint margin
- Cytokeine production & decreased ROM causes juxtarticular osteoporosis
- Fibroblasts grow along blood vessels between synovium and epiphyseal bone cavity and damage the bone
-
What happens in the DEFORMITY phase in Rheumatoid Arthritis
- Erosions lead to deformity which contribute to long term disability
- Combinations of articular destruction, capsule stretching and tendons rupturing
- Results in instability and deformity (ulnar deviation, bouchard's nodes, swan neck, boutinierres
- Nodules may presesnt in soft tissues
-
PINK PUFFERS best describes
Emphysemia
-
BLUE BLOATERS best describes
Chronic Bronchitis
-
Define primary and secondary Osteoarthritis
- Primary = Effects healthy joints not previously affected
- Secondary = Effects injured or deformed joints
-
Features of Rheumatoid Arthritis (RHEUMATISM)
- (RHEUMATISM)
- Rheumatoid factor + & Radial deviation
- HLA-DR1 and DR-4
- ESR/Extra-articular features (restrictive lung disease, subcutaneous nodules)
- Ulnar deviation of fingers
- Morning stiffness/MCP+PIP joint swelling
- Ankylosis/Atlanto–axial joint subluxation/Autoimmune/ANA +ve in 30%
- T-cells (CD4)/TNF
- Inflammatory synovial tissue (pannus)/IL-1
- Swan-neck deformity, Boutonniere deformity, Z-deformity of thumb
- Muscle wastage of small muscles of hand
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Ankylosing spondylitis clinical features (SPINAL)
- Sacroiliac and low back pain
- Pleuritic chest pain
- Inherited gene marker: HLA-B27 (>90% HLA-B27 +ve, general populationfrequency – 8%)
- Neck hyperextension – question mark posture
- Arthritic symptoms in peripheries (asymmetrical)
- Loss of spinal movement which is progressive
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Psoriasis is an accelaration of skin cells that do not fully mature, with the normal skin rejuvinating process taking 21 days, psoriasis takes 2 - 6 days and can be identified by...
Red, flaky, crusty patches with silvery scale covering on the extensor surfaces
-
Pathological change to the cartilage in OSTEOARTHRITS
- Increase in CHONDROCYTE production
- Increases Aggrecans but decreases Aggrecan
- Collagen II scaffold collapses
- Fissures appear in cartilage
- CHONDROCYTE death
- Decrease in cartilage thickness
- Cartilage loss is focal on weight bearing joints - medial condyle of knee
- OA cartilage increases deposition of calcium and crystals
-
Pathological change to bone in OSTEOARTHRITIS
- BONE below cartilage INCREASES THICKNESS
- CYSTS develop due to OSTEONECROSIS due to pressure on bone
- New FIBROCARTILAGE OSSIFIES to form OSTEOPHYTES
- EBURNATION + DEEP GROOVES form
- REMODELLING + CARTILAGE THINNING = ALTERED JOINT & INCREASE SURFACE AREA
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7 signs of Crohns disease (IBD)
- 1 - Small bowel (80%) and GIT
- 2 - Colonic involvement is RIGHT sided
- 3 - Fistulas
- 4 - Perianal lesions
- 5 - Asymmetrical and segmental (X-ray)
- 6 - Patchy and discrete ulcerations (Endoscopic)
- 7 - Epithelioid granulomas in bowel and lymph in 25 - 50% of cases
-
7 signs of Ulcerative Colitis (IBD)
- 1 - Confined to COLON
- 2 - Colonic involvement is LEFT sided
- 3 - No Fistuals
- 4 - No perianal lesions
- 5 - Symmetrical and constant (X-ray)
- 6 - Uniform yet diffuse (Endoscopic)
- 7 - No epithelioid granulomas
-
IBS is also known as
Spastic Colitis (Mucosa)
-
Hemoptysis is
coughing up blood, this arises from the bronchial circulation.
-
Stridor is
- HIGH pitched,
- INSPIRATORY sound
- EXTRAThoraic
- UPPER airway OBTRUCTION
-
Asthma is defined as
- Disease of diffuse airway inflammation
- Varying triggers
- Partial or complete Bronchoconstriction
-
4 Clincial features of ASTHMA are............
Maybe misdiagnosed with (1)................
And has recently been related to (2) .......
- Difficult or uncomfortable breathing
- Chest tightness
- Wheezing
- Experation is prolonged
- COPD
- GERD
- Rhinitis
-
Chronic Obstructive Pulmonary Disease (COPD) comprises of what diseases
- Chronic Obstructive Bronchitis - is chronic bronchitis with airflow obstruction a.k.a.: (chronic mucous hypersecretion syndrome)
- Emphysema - is destruction of parenchyma leading to loss of elastic recoil, loss of alveolar septa and radial airway leading to collapse of lung
-
What differentiate COPD and ASTHMA
- Onset is gradual with COPD
- History
- Reversibility of airflow obstruction
-
Ischemic Heart Disease can be divided into 4 catagories (you do the SUMS)
- Stable angina
- Unstable angina
- Myocardial infarction
- Sudden cardiac death
-
Atherosclerosis can be described as
- Atherosclerosis is a condition in which fatty material collects along the walls of arteries.
- This fatty material thickens, hardens (forms calcium deposits), and may eventually block the arteries.
-
Chronic Liver Disease maybe caused by...
- Hepititis B, C or D
- Drugs
- Inflammatory Bowel Disease (UC & Crohns)
- Autoimmune
-
Typical clinical signs of CHRONIC Liver disease are
- Jaundice
- Fever
- Loss of body hair
- RUQ Pain
- Pruritus
- Duputrens Contracture (as pcitured)
-
Acute Liver failure is caused by.....
- Toxic agents, arsenic, phosphorus, or iron.
- Acute viral hepatitis, a fatty liver during pregnancy, sepsis, Wilson's disease, Reyes Syndrome, and hypoxia also cause the liver to fail acutely.
-
Clinical features of Acute Liver failure
- Nausea
- RUQ Pain
- Reduced appetite
- Jaundice
- Dark urine
- Light stools
- Complications are hypoglycemia, and GI bleeds
-
Common causes of Chronic Liver failure are
- Liver Cancer
- Cirrhosis
- Hepatitis B, C and D
-
Fibromyalgia definition and 18 points of tenderness
- Fibromyalgia is a negative diagnosis
-
Common points between Fibromyalgia and Myofascial pain syndrome
- Both are chronic conditions
- Both related to depression
- Both are not clearly understood
-
hyperalgesia and allodynia are best described as .......... and are linked to which disorder
- Hyperalgesia - when you are extremely sensitive to pain
- Allodynia - when you feel pain from something that should not be painful at all, such as a very light touch
- Both linked to FIBROMYALGIA
-
3 cancers affecting the Thyroid
- Papillary Carcinoma
- Follicular Carnicoma
- Medullary Carcinoma
-
Define carcinoma
a malignant new growth made up of epithelial cells tending to infiltrate surrounding tissues and to give rise to metastases.
-
Define Lymphoma
its a cancer of the lymphatic system
-
Lymphoma can be catagorised into 2 types.....
- Hodgkins Lymphoma
- Non-Hodgkins Lymphoma
-
Non Hodgkins Lymphoma characters (7)
- Reed - Sternberg Cell - NOT PRESENT
- Can affect B & T Lymphocytes
- Common
- 2 types - High & Low grade
- High Grade is aggressive
- Low grade is progressive
- Chances increase with age (65 is average age)
-
Hodgkins Lymphoma characters (Only Present)
- Reed - Sternberg is PRESENT
- Affects B-Lymphocytes ONLY
- Rare
- No subcatagories
- Aggresive
- Any age, but common in young
-
Cervical spondylosis is also know as
Cervical Arthritis - found in the elderly
-
Complications of cervical spondylosis
- Radiculopathy - Damage to Radicular collar causing peripheral neuropathy
- Myelopathy - spinal stenosis
-
Spondylolysis is
a defect of the pars interarticulars
-
Vascular disease, RA, HIV and Type II diabetes can cause ...
Acute Osteomyelitis
-
Acute Osteomyelitis can be caused by
- Vascular disease
- Type II Diabetes
- RA
HIV
-
Chronic Osteomyelitis can be caused by
-
Clinical presentation of OSTEOMYELITIS
- Decrease ROM
- Inflammation
- Drainage/Sinus
-
Osteopetrosis is
- An inherited disorder
- Insufficent OSTEOCLASTIC activity
- Bone grows at detriment of marrow space = Anemia
-
Definition of Tendon (itis), (osis) and (opathy)
- Tendonitis - Inflammation of the tendon
- Tendonosis - Degeneration without inflammation
- Tendonopathy - Is general term for a pathology
-
5 causes of a ischemic stroke
- Thrombosis (obstruction of a blood vessel by a blood clot forming locally)
- Embolism (obstruction due to an embolus from elsewhere in the body)
- Systemic hypoperfusion (general decrease in blood supply, e.g. in shock)
- Venous thrombosis
- Intercerebral Hemorrhage
-
FAST stroke screen consists of
-
Confusion, leg pain, stiff neck and photophobia.....
!!!!Meningitis!!!!
-
2 common motor neuron diseases are.....
- Parkinsons
- Multiple Sclerosis
-
Parkinsons disease pathology is.....
- Substantia Nigra produces Dopamine (neurotransmitters)
- Parkinsons disease kills the Substantia Nigra cells
- Dopamine is reduced
- = Hypokinesia
-
Clinical features of Parkinsons disease (TRAPS)
- Tremor at rest
- Rigidity
- Akinesia
- Postural (stoop)
- Stare
It is progressive and incurable at present
-
Multiple sclerosis pathology
Autoimmune disease that caused demylination and sclerosis in parts of the brain and spinal cord
-
Clinical features of Multiple sclerosis
-
Clinical features of CREST
-
CREST syndrome is also known as
Systemic Scleroderma
-
Severs disease and Osgood Schlatters have what common pahtology in common
Apophysitis
-
Apophysitis is termed as (COR)
- Chronic Avulsion
- Osteonecrosis
- Repetitive microtrauma
-
Apophyositis usually happens at 3 main sites....
- Ischial tuberosity
- Tibial tuberosity
- Calcaneal tuberosity
-
Addisons disease is known as...
- Primary adrenal insufficiency
- Hypoadrenalism
-
Addisons Disease disrupts the production of the steriod hormones...
- Cortisol
- Aldosterone (sounds like Addisons)
-
Functions of CORTISOL(Glucocorticoide) in Addisons
- Maintains blood pressure and blood glucose
- Suppresses immune system
- Regulates metabolism
-
Functions of ALDOSTERONE (Mineralcortoide
- Balances salt and water
- Helps the kidneys keep hold of the sodium in the blood, while removing the potassium.
- If the kidneys cannot do this properly, the volume of blood falls.
- If there is less blood being pumped around the body, blood pressure will drop.
-
Too little cortisol will cause
Addisons Disease
-
Too much Cortisol will cause
- Cushings Disease
- (Cortisol bounces HIGH off the Cushing)
-
Clinical features of CUSHINGS
-
Clinical features of ADDISONS
- Weakness
- Anorexia
- Weight loss
- Impotence/amenorrhea
- Fever
- Depression
-
Possible causes of swollen(DIP) Distal Inter Phalangeal = SPROG
- Sarcoidosis
- Psoriasis
- Rieters
- OA
- Gout
-
4 A's of Ankylosing Spondylitis
- Apical fibrosis
- Anterior uveitis
- Aortic regurg
- Achilles tendonitis
-
Stills disease is also known as
Juevenile Arthritis
-
Seronegative arthrotides (SCRAP BW)
- Stills
- Colitis
- Reiters
- Ankylosing Spondylitis
- Psoriasis
- Bechets
- Whipples
-
MCV <80 describes what anaemia
Microcytic
-
MCV >96 fL desribes what anaemia
Macrocytic
-
Iron deficincy is classed as
Microcytic Anaemia
-
Thalassaemia is classed as
Microcytic anaemia
-
Siderblastic anaemia is a sub class of which anaemia
Microcytic anaemia
-
Sub-classes of microcytic anaemia are
- Thalasaemia
- Chronic Disease
Iron deficiency- Siderblastic
- (The Chronic Iron Cider)
-
3 types of anaemia
- Microcytic - Micromachines were made of IRON
- Normocytic
- Macrocytic - Large immature blood cells (B12 & Folate)
-
Microcytic anaemia pathogenesis is mainy a reduction
- MCH - Mean Corpuscular Haemoglobin
- MCHC - Mean Corpuscular Haemogloin Concentration
-
Iron deficiency maybe due to
- Blood loss - (menstrual)
- Absorption - (crohns & PMR)
- Pregnancy
-
Clincial features of Iron Deficiency (Microcytic Anaemia)
- Decrease in Epithelial Iron causing
- Brittle hair and nails
- Spoon shaped nails
- Pharangeal webs causing dysphagia
- Atrphic glossitis
-
Macrocytic anaemia is caused by
B12 &Folate deficiency
-
Subclasses of Marcocytic anaemia are
- Megaloblastic Anaemia
- Non-Megaloblastic Anaemia
-
Megaloblastic, the sub category of Macrocytic anaemia can be divided into 2 futher catagories, these are
- B12 & Folate deficiency
- Pernicious Anaemia
-
Pernicious anaemia is
- an autoimmune disorder
- causes atrophy to gastric mucosa
- = failure of INTRINSIC FACTOR
-
Common disorders during pregnancy
- Gestational Diabetes - Peripheral neuropathy
- Anaemia - B12 / Folate - Peripheral neuropathy
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