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47 Cards in this Set

  • Front
  • Back
Type II Hypersensitivity Reaction
-antibody mediated- IgG, IgM
-antibodies target endo/exogengenous antigens on cell surfaces or connective tissue causing inflammation and cell injury and abnormal cell function.
ex: myasthenia gravis, graves disease.
Type I Hypersensitivity Reaction
IgE mediated
begins rapidly with antigen exposure
es: anaphylactic, or local/atopic reactions
How does systemic lupus cause damage?
hyper reactive B cells form autoantiobodies against nuclear and cytoplasmic cell components.
AA's directl damage tissues by combining w/ antigens to form destructive tissue-immune complexes.
What are the defining features of SLE ?
-autoimmune colllagen-vascular disease.
-marked b-cell hyper reactivity
-can affect any organ system, may have mult. relapses/exacerbations.
-Immune system attacks native tissue.
How does SLE manifest?
butterfly rash, pleural effusion, heart problems, lupus nephritis, arthritis, Raynaud's,
Rheumatoid Arthritis
S/S
sub Q nodules
joint deformity
episcleritis
schleromalacia
nephritis
splenomegaly
pleural effusion
anemia
elevated ESR
pericarditis
etiology of RA
genetic
mediated by immune system
hormonal link-estradiol may be protective
microbial agent may act as trigger
Rheumatoid Arthritis
systemic autoimmune disease of the Connective Tissue, affects mainly synovial tissue.
symmetric joint involvement seen.
pathogenesis of RA
Rheum. Factor protein is a self produced antibody which reacts with IgG to form immune complexes- these activate the complement system and an inflammatory response occurs as the immune complexes precipitate in joints.
What is COPD?
disease of chronic/ recurrent obstruction of airflow
progressive inflammatory response to an irritant leads to:
-inflammation/fibrosis of bronchial wall
-hypersecretion of mucus d/t hypertroph of submucosal glands
-loss of elasticity of lung tissue.

smoking most common cause
a1-antitrypsin deficiency is an autosomal rec essive disorder which may account for COPD in pt <40 y/o.
COPD treatment course
smoking cessation
pulmonary rehab
bronchodilators, corticosteroids, theophylline.
02
a1 antiT enzyme replacment.
lung volume reduction surgery
bullaectomy
Lung transplant.
Signs and Symptoms COPD
prolonged expiratory pahse
+wheeze/rales
increased WOB and retractions
exertional dyspnea
hypoxemia
hypercapnia
cyanosis
polycythemia
cor pulmonale
exacerbations of diesease w/ resp distress and failure.
chronic bronchitis
increase in goblet cells, hypersecretion of mucus
submucosal hypertrophy
airway obstruction
chronic productive cough
fibrosis of bronchiolar wall
emphysema
loss of lung elasticity
enlargement of airspaces distal to terminal bronchioles
destruction of alveolar walls and capillary beds
hyperinflation of lungs with increased total lung capacity
Bronchiolitis Diagnosis
diagnosed with:
physical exam
CBC's, virology
CXR, Chest CT
PFT's
adults: lung biopsy
treatment of bronchiolitis
mainly supportive
nasal wash
fluid replCEMENT
humidified o2
antipyretics
what are the different types of pulmonary Artery Hypertension?
idiopathic
genetic: related to BMPR-2 gene
assoc. w/ other disorders: collagen vascular dz, HIV, COPD,meth use etc.
what are the pressure assoc. with Pulm. Art. HTN?
mean PA pressure >25mmhg, or >30 w/exertion
pulmonary wedge pressure >15mmhg
WHat is the pathophysiology of PAH?
-essentially endothelial dysfunction.
-overproduction of vasoconstrictors (thromboxane and endothelin)
-decreased production of vasodilators (NO, prostaglandin)
-abnormal contraction of vascualr smooth muscle, coagulopathies, fibrosis of pulmanary artery endothelium leading to stenosis and obstruction.
important facts about pulmonary ciculation
-vessels are wide and thin walled
-generally a high flow, low pressure, low resistance circuit
-double artery blood supply
PAH Treatment
anticoags
round the colck 02
oral bosentan/ sildenafil
inhlaed prostaglandin/ NO
flolan
Lung transplant
what diagnostics would you use when suspecting PAH?
History and Physical
ECG (RA enlargement)
CXR
echo
PFT's
VQ scan
chest/Spiral CT
HIV assay
6 minute walk test
R heart cath and vasoreactivity
List the signs and symptoms of PAH
exertional dyspnea
excessive fatigue
weakness
Chest PAin
dizziness/ syncope
peripheral edema/ ascites
JVD
precordial heave
Split s2 with loud p2
how does PAH lead to RV failure
increased RV pressure and RV volume overload leads to RV hypertrophy, decreased contrctility, tricuspid valve regurgitation, decreased coronary artery blood flow to RV leads to ischemia
poor prognosis once RVF sets in
what are the hallmarks of irreversible PAH?
Vascular lesions
loss of response to short acting bronchodilators
tricuspid regurgitation
right heart failure
what is pulmonary capillary wedge pressure?
intravascular pressure as measured by a catheter wedged into a distal pulmonary arteriole. indirectly measures left atrial pressure.
obturator sign
with pt supine, flex right leg and roate ankle interiorlly, like a glute stretch, to stretch the internal obturaor. If this provokes pain it is a sign of inflammation.
Psoas SIgn
with pt supine, have them attempt to flex hipagainst resistence. +Pain= possible retrocecal appendix
if cannot extend hip while laying on side= ileopsoas
Appendicitis exam findings
tenderness over area of inflamed appendix
rebound tenderness RLQ
+psoas or Obturator signs
what is the classic presentation of appendicitis?
anorexia with steady dull aching peri-umbilical pain that localises to RLQ in 4-6 hours
N/V after onset of pain
low grade fever
+guarding, +distention.
Murphy's Sign
have pt take deep breath, palpate deeply with inhale at MCL
Sharp pain = +Murphy's sign
inidicative of choleycystitits
What four abnormalities of the heart are present is Tetrology of Fallot
1. narrowed pulmonary valve
2.thickened RV wall
3. Displacement of Aorta over VSD
4. VSD
What kind of congenital heart defect is Tet. of Fallot?
Cyanotic disorder with right to left shunting
What are some diagnostic hallmarks of Tet.of Fallot?
RVH on EKG
"boot shaped" heart on CXR
echo/angio show VSD, pulmonic stenosis and over-riding aorta
Cath reveals equivalent RV/LV pressures and decreased PA pressure, with low o2 sats in aorta
What are some assessment findings consistant with Tet. of Fallot?
-Hypercyanotic "Tet" spells with crying or exertion
pulmonary systolic ejection murmur
Heave palpable at RV border
child may be in "squatting" position which increases SVR, and decreased venous return
Treatment of TOF
total surgical correction before 1 year
blalock-tuassig shunt to improve pulm. blood flow
VSD patch, resection pulmonic vlave, patch the RV outflow tract
How does a ventricular-septal defect affect the heart?
1. creates left to right shunting of blood.
2. fluid overload leads to thickening, stenosis, of pulmonary vessels.
3. increases the pulmonary vascular resistance.
What kind of murmur is associated with VSD?
loud harsh holosystolic murmur with a systolic thrill.
What Kind of murmur is assoc. with an ASD?
crescendo/ decrecendo systolic ejection murmur with a split s2
how does and atrial-septal defect affect the heart?
RA and RV enlargement
increased R heart volume leads to delayed closure of pulmonic valve.
increased rich of pulmonary vascular disease as an adult.
best confirmed with an echo.
risk factors for pancreatic adenocarcinoma
65-80 y/o
smoking
chronic pancreatitis
chemical exposures
DM in non obese pt <50 y/o
BRCA, P16 mutations
5 possible pancreatic neoplasms
ductal adenocarcinoma
cysytic neoplasms
acinar cell carcinoma
islet cell tumors
lymphoma
causes of chronic pancreatitis
NOT likely cause by Acute panc.
Alcohol is #1
genetic predispostion
Cystic fibrosis
tumors/ductal obstruction
malnutrtion
smaoking
trauma
Chronic Panc. patho.
chronic inflammatory process that causes glandular fibrosis and atrophy of endocrine & exocrine tissue.
leads to ductal obstruction
S/S of chronic Panc.
upper ABD pain
n/v
weaight loss
fatty stools
low lipase level
diabetes
Treatment for Acute Pancreatitis
NPO
Fluid replacement is ESSENTIAL
02
pain management
consider ICU admit if necessary
causes of Acute Pancreatitis
gallstones/microlithiasis >75%
alcohol
toxins/Rx--> azathioprine, OCP, thiazides
ABD Trauma
malignancy
hypertriglyceridemia
idiopathic