Essential Internal Med Diagnoses pt 2 Flashcards
(48 cards)
autoantibodies for ehrymatoid arthritis
Genetics: HLA-DR1/4
Antibodies: Rf, anti-CCP
is rheumatory arthritis an example of inflammatory or non-infl arthritis?
inflammatory. RA is characterizes by stiffness in the mornings/after rest, systemic symptoms, variable joint patterns.
osteoarthritis is progressive deterioration of __ ___ and surrounding joint structures caused by factors with secondary components of inflamation
deterioration of articular cartilagre. abnormalities in biomechanical forces –> proinflammatory cytokines –> degradation of proteoglycans by MMPS, –> fissuring, cartilage loss and subcondral bone thieckening.
T/f in osteoarthritis, activity makes the pain lesson (like in RA)
false. activity makes the pain worse, rest makes it better.
4 hallmark features of osteoarthritis on XRAY
- joint space narrowing
- osteophytes
- subchondral sclerosis
- bone cysts.
T/F people with anklysing spondylitis are positive for RF antibody (like in RA)
false. AS, psoriatic arthritis and reactive arthritis are examples of SERONEGATIVE arthropatheies in which they are negative for antibodies. they are assocaited with HLA-b27 though.
key seronegative arthropathy that has significant sacroiliitis and enthesitis
ankylosing spondylitis.
anchor drug for psoriatic arthritis
methotrexate
Sarcoidosis and amyloidosis are infiltrative disesase that can lead to ___ cardiomyopathies. What is the mechanism?
restrictive cardiomyopahties; impaired ventricular filling with preserved systolic function in a non-dilated, non-hypertrophied ventricle, seconary to factors that decreased myocardial compliance.
Mechanism: reduced ventricular compliance –> increased LVEDP –> increased pulmonary venous pressure + decreased CO.
Definition: idiopathic non-infectious granulomatous multi-system disease with lung involvedment in 90% of cases. Symptoms include chest symptoms like cough, dyspnea, chest pain, as well as skin changes like erythema nodosum, lupus pernio ,cardiac arrythmias, eveitis, arthralgia, peripheral lymphadenopathy, hepatosplenomegaly.
Sarcoidosis
Lofgren’s syndrome symptoms and disease association
LEAF: lymphadenopathy, erythema nodosum, arthralgias, fever –> sarcoidosis.
when do you not need to biopsy the lung in order to confirm sarcoidosis?
when the person has lofrgrens syndrome.
last stage of sarcoidosis key xray/ct findings.
pulmonary fibrosis /honey combing on xray
general treatments for sarcoidosis
- stages 1 and II often resolve spontaneously
- prednisone for other stages
NSAIDS if lofgrens.
classic ECG and physical exam findings of pericarditis, and key management strategies for it
ECG findings: diffuse ST elevation and PR depression.
PE: Audible friction rub, which is the movement of inflamed pericardial layers against each other.
treatment: high ASA, NSAIDS, colchicine to reduce recrrance.
Beck’s triad of pericardial effusion
low BP, elevated JVP, muffled heart sounds
key physical exam findings for pericardial effusions
Beck’s triad (low BP, elevated JVP, muffled heart sounds), tachycardia, pulsus paradoxus.
ECG is gold standard for detection– can lead to pericardial tamponade, which shows low voltage, sinus tachycardia and electrical alternans due to heart swing. –> emergency
etiology of aortic dissection
HTN (90% of cases), heritable disease (Marfans, EDS, Turner syndrome), aneurysm, iatrogenic (catheter/surgical), vasculitis, chronic syphilis infection, bicuspid AV
type A and B aortic dissection, and how they differ in management
A. proximal flap in the ascending aorta–> surgical management
B. Distal flap in the aorta–> IV beta blockers, vasodilators, stents.
complications of either type can lead to sudden death, cardiogenic shock, hemodynamic instability, pericardial effusion, pericardial tamponade, MI and aortic insufficiency.
note: be aware of the two key types of aortitis: giant cell and takayasu– plus patient profile.
Aortitis Definition: inflammatory diseases of the aorta Examples:
• Giant Cell Aortitis: 55+ F, often associated to temporal artertitis, can cause aneurysm/dissections
• Takayasu’s Aortitis: young F, occlusive disorder of aortic branch vessels (pulseless disease), associated with eye problems
Management: steroids
S3 sound is elicited by high ___ sided pressures of the heart
left sided presures
elevated JVP, hepatomegaly, ascietes nad peripheral edema is due to ___ sided heart failure/elevated __sided pressuers
high right sided pressure.
outline the neurohormonal compensatory mechanism in left heart failure
reduced cardiac output due to LHF–> back up of blood into L atrium –> back up in pulmonary circulation –> pulmonary edema –> reduced gas exchange and dyspnea .
this reduced CO –> reduced perfusion of renal artery –> RAAS and adrenergic activation –> renal salt and water retention –> more edema even though theres already pulmonary edema –> increased contractility and increased circulating volume –> increased cardiac outpupt –> organ perfusion –> increased afterload –> increaed LV workload, LV remodelling –> harmful
this is a good mechanism if it’s not chronic. but in LHF, it is.
leads to S3 and S4 sounds.
exertional dyspnea, orthopnea, pulmonary edema (frothy, pink-tinged sputum), bibasilar rales, cough, nocturia, restlessness, confusion and S3/S4
these are symptoms of ___ sided heart failure
left heart failure
