Clinical Med 2

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Author:
talmage76
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87330
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Clinical Med 2
Updated:
2011-05-29 18:19:50
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clinical med
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Description:
UC, Crohns, hyper, hypothyroidism, L&R Heart failure, RA
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  1. LEFT sided heart failure is commonly caused by
    Ischaemic heart disease
  2. Ischaemic heart disease irreversible risk factors are:
    • Age
    • Gender
  3. Ischaemic heart disease reversible risk factors are:
    • Hyperlipidaemia
    • Smoking
    • Hypertension
    • Hyperhomocystinaemia
    • Diabetes
  4. As well as ischaemic heart disease, what are the other causes of LEFT sided heart failure
    • Systemic hypertension
    • Aortic valve disease
    • Mitral valve disease
  5. Pulmonary congestion will present with
    • Orthopnoea - DIB when lying flat
    • Paroxysmal Nocturnal Dyspnoea - Waking up suddenly DIB
    • Fatigue
  6. 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
  7. Most frequent cause of RIGHT sided heart failure is
    LEFT sided heart failure is normally primary and RIGHT is secondary
  8. A patient presents with pain in the RUQ, jugular vein distension or pitting oedema what should be suspected
    RIGHT sided heart failure
  9. Biventricular heart failure is also known as
    Congestive heart failure
  10. Combination of LEFT and RIGHT sided heart failure can be described as
    Congestive heart failure
  11. 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
  12. 2 types of LEFT sided heart failure are
    • Systolic - Left ventricle loses ability to PUMP
    • Diastolic - Left ventricle loses ability to RELAX
  13. 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
  14. Differences between LEFT and RIGHT sided heart failure
    • Left affects the LUNGS= DIB
    • RIGHT affects the BODY = Oedema
  15. Mean age in HYPOthyroidism & HYPERthyroidism varies
    • HYPER - 20 -40
    • HYPO - 60
  16. HYPO is to Hashimotos, as HYPER is to
    Graves
  17. HYPER is to Graves as HYPO is to
    Hashimotos
  18. Levothyroxine is treatment for
    Hypothyroidism
  19. Thyroxine is treatment for
    Hypertyroidism
  20. High levels of T3 & T4 will cause
    Hypethyroidism
  21. Low levels of T3 & T4
    Hyporthyroidism
  22. 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
  23. List 8 clinical presentations of HYPERTHYROIDISM (SWEATING)
    • Sweating
    • Weight loss
    • Emotional instability
    • Appetite increased
    • Tremor/Tachycardi
    • Irregular periods
    • Nervousness
    • Goitre
  24. There is a HLA and genetic link in Ulcerative Colitis, what are the 2 types of UC
    • Rectum = Proctitis
    • Colon = Pancolitis
  25. 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
  26. 5 Complications of Ulcerative Collitis
    • Perforation
    • Gall stones
    • Colorectal cancer
    • Haemorrage
    • Toxic megacolon
  27. 10 common factors of UC and Crohns
    • Abdominal distension
    • Diarrhoea with blood
    • Aneamia
    • Clubbing
    • Fever
    • Malaise
    • Sacrolitis
    • Conjunctivits
    • Large joint arthralgia
    • Oral Ulcers
  28. 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.
  29. 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
  30. 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
  31. 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
  32. 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
  33. PINK PUFFERS best describes
    Emphysemia
  34. BLUE BLOATERS best describes
    Chronic Bronchitis
  35. Define primary and secondary Osteoarthritis
    • Primary = Effects healthy joints not previously affected
    • Secondary = Effects injured or deformed joints
  36. 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
  37. 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
  38. 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
  39. 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
  40. 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
  41. 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
  42. 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
  43. IBS is also known as
    Spastic Colitis (Mucosa)
  44. Hemoptysis is
    coughing up blood, this arises from the bronchial circulation.
  45. Stridor is
    • HIGH pitched,
    • INSPIRATORY sound
    • EXTRAThoraic
    • UPPER airway OBTRUCTION
  46. Asthma is defined as
    • Disease of diffuse airway inflammation
    • Varying triggers
    • Partial or complete Bronchoconstriction
  47. 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
  48. 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
  49. What differentiate COPD and ASTHMA
    • Onset is gradual with COPD
    • History
    • Reversibility of airflow obstruction
  50. Ischemic Heart Disease can be divided into 4 catagories (you do the SUMS)
    • Stable angina
    • Unstable angina
    • Myocardial infarction
    • Sudden cardiac death
  51. 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.
  52. Chronic Liver Disease maybe caused by...
    • Hepititis B, C or D
    • Drugs
    • Inflammatory Bowel Disease (UC & Crohns)
    • Autoimmune
  53. Typical clinical signs of CHRONIC Liver disease are
    • Jaundice
    • Fever
    • Loss of body hair
    • RUQ Pain
    • Pruritus
    • Duputrens Contracture (as pcitured)
  54. 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.
  55. Clinical features of Acute Liver failure
    • Nausea
    • RUQ Pain
    • Reduced appetite
    • Jaundice
    • Dark urine
    • Light stools
    • Complications are hypoglycemia, and GI bleeds
  56. Common causes of Chronic Liver failure are
    • Liver Cancer
    • Cirrhosis
    • Hepatitis B, C and D
  57. Fibromyalgia definition and 18 points of tenderness
    • Fibromyalgia is a negative diagnosis
  58. Common points between Fibromyalgia and Myofascial pain syndrome
    • Both are chronic conditions
    • Both related to depression
    • Both are not clearly understood
  59. 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
  60. 3 cancers affecting the Thyroid
    • Papillary Carcinoma
    • Follicular Carnicoma
    • Medullary Carcinoma
  61. Define carcinoma
    a malignant new growth made up of epithelial cells tending to infiltrate surrounding tissues and to give rise to metastases.
  62. Define Lymphoma
    its a cancer of the lymphatic system
  63. Lymphoma can be catagorised into 2 types.....
    • Hodgkins Lymphoma
    • Non-Hodgkins Lymphoma
  64. 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)
  65. Hodgkins Lymphoma characters (Only Present)
    • Reed - Sternberg is PRESENT
    • Affects B-Lymphocytes ONLY
    • Rare
    • No subcatagories
    • Aggresive
    • Any age, but common in young
  66. Cervical spondylosis is also know as
    Cervical Arthritis - found in the elderly
  67. Complications of cervical spondylosis
    • Radiculopathy - Damage to Radicular collar causing peripheral neuropathy
    • Myelopathy - spinal stenosis
  68. Spondylolysis is
    a defect of the pars interarticulars
  69. Vascular disease, RA, HIV and Type II diabetes can cause ...
    Acute Osteomyelitis
  70. Acute Osteomyelitis can be caused by
    • Vascular disease
    • Type II Diabetes
    • RA
    • HIV
  71. Chronic Osteomyelitis can be caused by
    • TB
    • Syphilis
  72. Clinical presentation of OSTEOMYELITIS
    • Decrease ROM
    • Inflammation
    • Drainage/Sinus
  73. Osteopetrosis is
    • An inherited disorder
    • Insufficent OSTEOCLASTIC activity
    • Bone grows at detriment of marrow space = Anemia
  74. Definition of Tendon (itis), (osis) and (opathy)
    • Tendonitis - Inflammation of the tendon
    • Tendonosis - Degeneration without inflammation
    • Tendonopathy - Is general term for a pathology
  75. 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
  76. FAST stroke screen consists of
    • Face
    • Arm
    • Speech
    • Time
  77. Confusion, leg pain, stiff neck and photophobia.....
    !!!!Meningitis!!!!
  78. 2 common motor neuron diseases are.....
    • Parkinsons
    • Multiple Sclerosis
  79. Parkinsons disease pathology is.....
    • Substantia Nigra produces Dopamine (neurotransmitters)
    • Parkinsons disease kills the Substantia Nigra cells
    • Dopamine is reduced
    • = Hypokinesia
  80. Clinical features of Parkinsons disease (TRAPS)
    • Tremor at rest
    • Rigidity
    • Akinesia
    • Postural (stoop)
    • Stare
    • It is progressive and incurable at present
  81. Multiple sclerosis pathology
    Autoimmune disease that caused demylination and sclerosis in parts of the brain and spinal cord
  82. Clinical features of Multiple sclerosis
  83. Clinical features of CREST
  84. CREST syndrome is also known as
    Systemic Scleroderma
  85. Severs disease and Osgood Schlatters have what common pahtology in common
    Apophysitis
  86. Apophysitis is termed as (COR)
    • Chronic Avulsion
    • Osteonecrosis
    • Repetitive microtrauma
  87. Apophyositis usually happens at 3 main sites....
    • Ischial tuberosity
    • Tibial tuberosity
    • Calcaneal tuberosity
  88. Addisons disease is known as...
    • Primary adrenal insufficiency
    • Hypoadrenalism
  89. Addisons Disease disrupts the production of the steriod hormones...
    • Cortisol
    • Aldosterone (sounds like Addisons)
  90. Functions of CORTISOL(Glucocorticoide) in Addisons
    • Maintains blood pressure and blood glucose
    • Suppresses immune system
    • Regulates metabolism
  91. 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.
  92. Too little cortisol will cause
    Addisons Disease
  93. Too much Cortisol will cause
    • Cushings Disease
    • (Cortisol bounces HIGH off the Cushing)
  94. Clinical features of CUSHINGS
  95. Clinical features of ADDISONS
    • Weakness
    • Anorexia
    • Weight loss
    • Impotence/amenorrhea
    • Fever
    • Depression
  96. Possible causes of swollen(DIP) Distal Inter Phalangeal = SPROG
    • Sarcoidosis
    • Psoriasis
    • Rieters
    • OA
    • Gout
  97. 4 A's of Ankylosing Spondylitis
    • Apical fibrosis
    • Anterior uveitis
    • Aortic regurg
    • Achilles tendonitis
  98. Stills disease is also known as
    Juevenile Arthritis
  99. Seronegative arthrotides (SCRAP BW)
    • Stills
    • Colitis
    • Reiters
    • Ankylosing Spondylitis
    • Psoriasis
    • Bechets
    • Whipples
  100. MCV <80 describes what anaemia
    Microcytic
  101. MCV >96 fL desribes what anaemia
    Macrocytic
  102. Iron deficincy is classed as
    Microcytic Anaemia
  103. Thalassaemia is classed as
    Microcytic anaemia
  104. Siderblastic anaemia is a sub class of which anaemia
    Microcytic anaemia
  105. Sub-classes of microcytic anaemia are
    • Thalasaemia
    • Chronic Disease
    • Iron deficiency
    • Siderblastic
    • (The Chronic Iron Cider)
  106. 3 types of anaemia
    • Microcytic - Micromachines were made of IRON
    • Normocytic
    • Macrocytic - Large immature blood cells (B12 & Folate)
  107. Microcytic anaemia pathogenesis is mainy a reduction
    • MCH - Mean Corpuscular Haemoglobin
    • MCHC - Mean Corpuscular Haemogloin Concentration
  108. Iron deficiency maybe due to
    • Blood loss - (menstrual)
    • Absorption - (crohns & PMR)
    • Pregnancy
  109. 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
  110. Macrocytic anaemia is caused by
    B12 &Folate deficiency
  111. Subclasses of Marcocytic anaemia are
    • Megaloblastic Anaemia
    • Non-Megaloblastic Anaemia
  112. Megaloblastic, the sub category of Macrocytic anaemia can be divided into 2 futher catagories, these are
    • B12 & Folate deficiency
    • Pernicious Anaemia
  113. Pernicious anaemia is
    • an autoimmune disorder
    • causes atrophy to gastric mucosa
    • = failure of INTRINSIC FACTOR
  114. Common disorders during pregnancy
    • Gestational Diabetes - Peripheral neuropathy
    • Anaemia - B12 / Folate - Peripheral neuropathy
  115. Pnuemonia

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