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47 Cards in this Set
- Front
- Back
Type II Hypersensitivity Reaction
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-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. |
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Type I Hypersensitivity Reaction
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IgE mediated
begins rapidly with antigen exposure es: anaphylactic, or local/atopic reactions |
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How does systemic lupus cause damage?
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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. |
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What are the defining features of SLE ?
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-autoimmune colllagen-vascular disease.
-marked b-cell hyper reactivity -can affect any organ system, may have mult. relapses/exacerbations. -Immune system attacks native tissue. |
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How does SLE manifest?
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butterfly rash, pleural effusion, heart problems, lupus nephritis, arthritis, Raynaud's,
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Rheumatoid Arthritis
S/S |
sub Q nodules
joint deformity episcleritis schleromalacia nephritis splenomegaly pleural effusion anemia elevated ESR pericarditis |
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etiology of RA
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genetic
mediated by immune system hormonal link-estradiol may be protective microbial agent may act as trigger |
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Rheumatoid Arthritis
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systemic autoimmune disease of the Connective Tissue, affects mainly synovial tissue.
symmetric joint involvement seen. |
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pathogenesis of RA
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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.
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What is COPD?
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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. |
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COPD treatment course
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smoking cessation
pulmonary rehab bronchodilators, corticosteroids, theophylline. 02 a1 antiT enzyme replacment. lung volume reduction surgery bullaectomy Lung transplant. |
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Signs and Symptoms COPD
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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. |
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chronic bronchitis
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increase in goblet cells, hypersecretion of mucus
submucosal hypertrophy airway obstruction chronic productive cough fibrosis of bronchiolar wall |
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emphysema
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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 |
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Bronchiolitis Diagnosis
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diagnosed with:
physical exam CBC's, virology CXR, Chest CT PFT's adults: lung biopsy |
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treatment of bronchiolitis
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mainly supportive
nasal wash fluid replCEMENT humidified o2 antipyretics |
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what are the different types of pulmonary Artery Hypertension?
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idiopathic
genetic: related to BMPR-2 gene assoc. w/ other disorders: collagen vascular dz, HIV, COPD,meth use etc. |
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what are the pressure assoc. with Pulm. Art. HTN?
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mean PA pressure >25mmhg, or >30 w/exertion
pulmonary wedge pressure >15mmhg |
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WHat is the pathophysiology of PAH?
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-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. |
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important facts about pulmonary ciculation
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-vessels are wide and thin walled
-generally a high flow, low pressure, low resistance circuit -double artery blood supply |
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PAH Treatment
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anticoags
round the colck 02 oral bosentan/ sildenafil inhlaed prostaglandin/ NO flolan Lung transplant |
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what diagnostics would you use when suspecting PAH?
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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 |
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List the signs and symptoms of PAH
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exertional dyspnea
excessive fatigue weakness Chest PAin dizziness/ syncope peripheral edema/ ascites JVD precordial heave Split s2 with loud p2 |
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how does PAH lead to RV failure
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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 |
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what are the hallmarks of irreversible PAH?
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Vascular lesions
loss of response to short acting bronchodilators tricuspid regurgitation right heart failure |
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what is pulmonary capillary wedge pressure?
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intravascular pressure as measured by a catheter wedged into a distal pulmonary arteriole. indirectly measures left atrial pressure.
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obturator sign
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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.
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Psoas SIgn
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with pt supine, have them attempt to flex hipagainst resistence. +Pain= possible retrocecal appendix
if cannot extend hip while laying on side= ileopsoas |
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Appendicitis exam findings
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tenderness over area of inflamed appendix
rebound tenderness RLQ +psoas or Obturator signs |
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what is the classic presentation of appendicitis?
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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. |
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Murphy's Sign
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have pt take deep breath, palpate deeply with inhale at MCL
Sharp pain = +Murphy's sign inidicative of choleycystitits |
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What four abnormalities of the heart are present is Tetrology of Fallot
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1. narrowed pulmonary valve
2.thickened RV wall 3. Displacement of Aorta over VSD 4. VSD |
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What kind of congenital heart defect is Tet. of Fallot?
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Cyanotic disorder with right to left shunting
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What are some diagnostic hallmarks of Tet.of Fallot?
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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 |
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What are some assessment findings consistant with Tet. of Fallot?
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-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 |
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Treatment of TOF
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total surgical correction before 1 year
blalock-tuassig shunt to improve pulm. blood flow VSD patch, resection pulmonic vlave, patch the RV outflow tract |
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How does a ventricular-septal defect affect the heart?
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1. creates left to right shunting of blood.
2. fluid overload leads to thickening, stenosis, of pulmonary vessels. 3. increases the pulmonary vascular resistance. |
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What kind of murmur is associated with VSD?
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loud harsh holosystolic murmur with a systolic thrill.
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What Kind of murmur is assoc. with an ASD?
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crescendo/ decrecendo systolic ejection murmur with a split s2
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how does and atrial-septal defect affect the heart?
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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. |
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risk factors for pancreatic adenocarcinoma
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65-80 y/o
smoking chronic pancreatitis chemical exposures DM in non obese pt <50 y/o BRCA, P16 mutations |
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5 possible pancreatic neoplasms
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ductal adenocarcinoma
cysytic neoplasms acinar cell carcinoma islet cell tumors lymphoma |
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causes of chronic pancreatitis
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NOT likely cause by Acute panc.
Alcohol is #1 genetic predispostion Cystic fibrosis tumors/ductal obstruction malnutrtion smaoking trauma |
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Chronic Panc. patho.
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chronic inflammatory process that causes glandular fibrosis and atrophy of endocrine & exocrine tissue.
leads to ductal obstruction |
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S/S of chronic Panc.
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upper ABD pain
n/v weaight loss fatty stools low lipase level diabetes |
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Treatment for Acute Pancreatitis
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NPO
Fluid replacement is ESSENTIAL 02 pain management consider ICU admit if necessary |
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causes of Acute Pancreatitis
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gallstones/microlithiasis >75%
alcohol toxins/Rx--> azathioprine, OCP, thiazides ABD Trauma malignancy hypertriglyceridemia idiopathic |