Cor pulmonale

How copd leads to cor pulmonale
Hypoxic pulmonary VC
pulmonary vascular remodelling
Lung hyperinflation– compresses the capillaries ( alveolar wall stretches)

REVISION CARDIO

Copied from wallnote.
For revision purposes
Cardiology Question
1) Give the mechanism and clinical significance of pulsus paradoxus?
2) Mechanism and clinical significance of 3rd heart sound to the left of the sternum?
3) Central cyanosis, its mechanism and clinical significance?
4) Clinical features of infective endocarditis?***
portal of entry:
majority unknown, dental, urethral,pelvic,cardiac surgery, strep bovis, iv drugs,
hosp acq
onset: insiduous+fever+malaise
neglected: “syndrome” 8
fever,anemia,tender sternum, tender splenomegaly, cardiac murmur, microscopic hematuria, skin petichae,clubbing
cardiac:
murmur: new or intensified
heart failure: intractable/laceration or perforation of valve
coronary emboli
mycotic aneurysm
extracardiac:(1neuro to sternum,4skin,1spleen,1urine)
neurological complication
tender sternum
skin petichae: conj,mouth, roths spot,janeway
osler nodule
splinter hge
clubbing
splenomegaly
proteinuria/mic hematuria
5) Enumerate causes and the pathogenesis of myocardial ischemia?
6) Clincal features & management of left ventricular failure**
7) Discuss investigation needed for diagnosis of pericardial effusion?***
CXR–>flusk shaped heart/water bottle heart
Echo–>increase pericardial space
ECG–>low amplitude QRS complex
pericardiocentesis (Echo guided)–>to relieve symptoms, C&S
8) Give brief treatment of paroxysmal atrial tachycardia?
9) Etiology and pathogensis of persistent dyspnea in the left heart failure?**
10) Clinical manifestation of cardiac temponade?*****
symptom : Dyspnea, tachycardia, tachypnea
sign : KEPp YB
kussmaul sign
Ewart sign
pulsus paradoxus
the y descent
Beck triad
11) Give treatment of infective endocarditis****
prophylaxic: dental hygiene
oral,oral,, respiratory, esophagus: amoxacillin 2gm PO 1hr b4
GU,GI: high risk–>amox/ampi 2gm IV+gentamycin1.5gm IV 1hr b4->ampi/amox 1gm PO aftr 6hr
mod risk–> ampi/amox 2gm IV b4
active medical: bactericidal,IV, min 4wks
Penicillin G iv 12-20mill U/24hr for 4weeks+-gentamycin 3mg/kg/24hr for 2 weeks
resistant: Vancomycin+gentamycin for 6 weeks
MRSA: native: vancomycin 15 mg/kg iv for 4-6 wks
PVE: VGR (6-2-6 wks)
culture -ve n complicated: Native: Vancomycin+gentamycin
PVE : VGR
12) Discuss briefly the etiology and pathogenesis of congested nect vein?
13) Give etiology and possible mechanism of heart failure?
14) Give etiology and possible mechanism of bradycardias?
15) Clinical features of dissecting aortic aneurysm
16) Treatment of acute myocardial infarction?**
a) AHA guideline if suspect MI–> Morphine, O2, Nitroglycerine, Aspirin
b) General Rx–>hosp, CCU, MONA, clopidogrel&statin, ACEI, B-blocker,LMWH
c) Specific Rx–> if w/in 30min: tPA/streptokinase/urokinase
if w/in 90min: PCI
17) Give clinical picture and complication of aortic valve insufficiency?
18) Etiology, clinical picture and management of left ventricular failure?*****
19) Give etiology and mechanism of angina pain?
20) Clinical picture and complication of constrictive pericarditis?**
CP: symptom
Gradual onset
dypsnea, fatigue, orthopnea
LL edema, abd swelling, discomfort
congestive symp : nausea vomiting
: rt upper quadrant pain
sign: KEPP YA
1) kusmaul sign 5) the y descent
2) Elevated jugular venous pressure 6) Apical impulse impalpable
3) pulsus paradoxus
4) pericardial knock
21) Investigations for ischemic heart disease?
22) Treatment acute rheumatic carditis?
23) Etiology,pathology, clinical manifestation, and treatment for infective endocarditis?
24) Give etiology and mechanism of basal systolic murmurs?
25) Clinical pictures of the acute rheumatic carditis?
26) Investigation for fever in cardiac patient?
27) Investigation needed for hypertension on young age?**
28) How to investigate hypertension?
29) Medical treatment for paroxysmal supraventricular tachycardia?
30) Cardiogenic shock ( ccu )
31) Discuss treatment of atrial fibrillation***
32) Clinical picture, diagnosis and management of acute myocardial infarction?**
33) Enumerate complication of acute myocardial infarction
34) 4 factors that may indicate bad prognosis in acute myocardial infarction?
35) Give short notes on treatment of congestive heart failure?****
36) Causes of hypertension?
37) Mention subacute bacterial endocarditis?
38) Causes & Diagnosis of co pulmonale?**
39) Treatment of acute heart failure?
40) Factor precipitating or aggravating heart failure?
41) Outline complication of mitral valve stenosis?
42) Investigation required in atrial fibrillation?
43) Medical treatment left ventricular failure?
———————————————————
GIVE THE ETIOLOGY & PATHOGENESIS OF:
l-Left ventricular failure
2-Pulmonary hypertension
3-Parenchymal cor pulmonale
4-Rheumatic fever
5-2ry hypertension
6-Renal hypertension
7 -Congested neck veins
8-Diastolic murmur on apex
9.Pulsus paradoxus
10-Continuous dyspnea
11-Bradycardias
12-Basal systolic murmur
13-Basal diastolic murmur
14-Tachycardias
15-Anginal pain
GIVE THE CLINICAL PICTURE OF:
1-Left ventricular failure
2-Anaphylactic shock
3-Pulmonary hypertension
4-Rheumatic fever
5-Mitral stenosis
6-Mitral incompetence
7 -Aortic stenosis
8-Aortic incompetence
9-Infective endocarditis
10-Myocardial infarction
11-Cardiac tamponade
12-Dissecting aortic Aneurysm
13-Constrictive pericarditis
14-Adhesive pericarditis

GIVE THE INVESTIGATIONS NEEDED FOR: u
1-Myocardial infarction
2-Infective endocarditis
3-Rheumatic fever
4-Left ventricular failure 5-Atrial fibrillation
6-Recurrent syncope
7- Hypertension in young
8- Pericardial effusion
GIVE THE TREATMENT O.F:
1-Acute left ventricular failure
2-Atrial fibrillation
3-Infective endocarditis
4-Rheumatic carditis
5-Acute myocardial infarction
6-Acute pulmonary edema
7 -Angina pectoris
8-Paroxysmal Atrial tachycardia
LONG QUESTIONS:
1-Give the etiology, pathophysiology, c/p, and management
of shock
2-Give account on: diagnosis and management of infective endocarditis
3-2ry Hypertension: Cause”s & Diagnostic features of 3 of them
4-Causes, clinical picture, investigations of Rt. & Lt. ventricular failure
5-Give an account on atrial fibrillation (causes, diagnosis & Rx)
6-Pulmonary hypertension (definition, causes, CP & investigations)
Definition: Right ventricular hypertrophy and dilatation secondary to pulmonary hypertension due to disease in the lung vessel and parenchyma and not due to left heart
causes: 1) Increase resistace to flow : large pulmonary artery
a) uni absence/stenosis
b) thromboembolism
: pulmonary vascular bed
a)
7-Mitral stenosis (pathophysiology, CP, complications & investigation)
8-Aortic stenosis (pathophysiology, CP, complications & investigation)
9-Aortic incompetence (pathophysiology, CP, complications & Ix) .’
10-Myocardial infarction (causes, CP, investigations & Rx)
11-Pericardial effusion (causes, CP, investigations & Rx)
12-Clubbing (Causes, grades & pathology) 13-Edema (Causes, mechanism & Diagnosis)

REVISION DIABETES

Past year questions

DIABETIC

1-Lines of treatment hyperTGdemia in diabetic pt (06,08)
2-Give short account on indication of insulin theraphy in type 2 DM
3-Mechanism in neuropathy in DM (95)
4-Cp of hypoglycemic coma (95)
5-Rx of DI (95)
6-Causes and pathogenesis of DKA (96,00)
7-Etiology and phatogenesis if hypoglycemia (02,05,07)
8-Rx of type-2 DM
9-Cardiovascular complication of DM (03)
10-Rx of DKA (03,08)
11-Skin changes in DM (03)
12-Enumerate 6 oral anti-diabetic agents (04,08)
13-Rx of diabetic microalbunuria (05)
14-Medical nutrition theraphy in DM (07)
15- Dx of gestational DM (07)
16-Approach to hyperglycemia pt (08)
17-Discuss non-pharma Mx of DM (08)
18-Features of Diabetic dyslipidemia (08)

Yeah

When we do a medic discussion i prefer it to be interactive,
To be productive, not just merely sticking to books or to what the doctors say. They may be right or wrong…but i like the discussion to be argumentative, not because we want to point out that our answer is right…Its ok if my answer is wrong, but i defend my answers because that is what i think is right…according to my opinion.everyone is entitled to their own opinions :)

I will defend my answer until someone comes along to tell me a reliable answer that i can depend on.

Because i am stubborn like that. Ha ha ha.

A healthy discussion is the way to go!!

Ok there i have said it.
So please be calm .i am not here to fight..i am just being defensive.teeeheeeee

Ecg, ami

There is always confusion around the terms third-degree heart block and AV dissociation. Dr. Chou makes a clear distinction in his book (see Additional Readings section): “The term complete AV block is used when the atrial rate is faster than the ventricular rate, whereas the reverse is true in AV dissociation. In AV block, there is a failure of impulse conduction even though the ventricles are receptive. In AV dissociation, there is an increase in the automaticity of the subsidiary pacemaker, which renders the ventricles functionally refractory to the slower atrial impulses.” These are the definitions we have used in this book.

Look at V1, which is usually the best place to see P waves

Myoglobin levels rise within 1-4 h fr onset of chest pain!!!! The earliest!!

Dont give nitrates in RV INFARCT , SHOCK, AORTIC STENOSIS, HYPOTENSION, CARDIOGENIC SHOCK

In 1st dgree heart block there is ONLY PROLONGATION OF PR BUT IN

2nd degree ( mobitz type 1) there is PROGRESSIVE PROLONGATION OF PR.

MOBITZ TYPE II –> there is constant PR BT OCCASIONALLY, THERE IS WITHOUT A QRS!!!
PLLLLLLLZZZZZZ INGAT SYG OIIIIIII

The triad of right vt infarction( hypotension, jugular venous distension, clear lung fields)

Its just a little crush

AaaaaaaaaAAAAAAAAAAAAAAAAAAAAA!!!!!!!!

My medic crush just replied my message medic questions regarding cardiology.duhh.

Im so happy!!!

Booster dose

20120617-114854.jpg

Despite the fact that i am falling in love for cardiology, i dont think its a wise idea to start and reveal my ambition to my parents….just yet.

My parents are almost perfectionist.they are somewhat insatiable to begin with. Even if you do so much,or your best, that just might not be the best for them. Plus, my dad has issues. I dont know why for some reasons he is very likely to underestimate my abilities. But its a motivational drive for me. I take the good side.no doubt, i get hurt at times. But being hurt is good .it keeps you strong.

People may wonder, how are you going to do this for the sake of allah. I am not an excellent candidate to answer that.but basically, if you love your CREATOR, you just want to do the best that you can. So that He will recognize you for doing something.

Just do your very best. Your very2 best!!!Maximum output ok!

Cardiology love!

I am falling head over heels over cardiology.
I am determined to become one!!! Biiznillah…

allah knows best.

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Jejunoileal atresia

20120609-162744.jpg

Type I:
intraluminal diaphragm or web may present with windsock anomaly.
NO MESENTERIC DEFECT
NORMAL LENGTH

Type II
Connected by fibrous atretic cord.
NO MESENTERIC DEFECT
NORMAL LENGTH

Type IIIA
NO FIBROUS CORD
VSHAPED MESENTERIC DEFECT
SHORTENED LENGTH

Type IIIB
bowel wraps around a single perfusing vessel( christmas tree app)
LARGE MESENTERIC DEFECT
SIGNIFICANTLY SHORTENED

Type IV
MULTIPLE DEFECTS

Whereas associated anomalies are found in 30-40% of neonates with duodenal atresias, associated anomalies are found in only 10% of neonates with jejunoileal atresias

There is maternal polyhydramnios

RX
RESECTION AND ANASTOMOSIS
TAPERING ENTEROPLASTy(for shortenede bowel)

From emedicine:

20120609-164335.jpg
Intestinal atresia type IIIa. A clamp is applied on the distal bowel, and sodium chloride solution is instilled through a purse-string suture to dilate the intestine and diminish the size discrepancy between the two loops to facilitate the anastomosis. The dotted line marks the area of the resection.

20120609-164644.jpg
The proximal dilated pouch is transected in a 90° angle to maximize its vascularity, while the distal intestine is transected obliquely to diminish the size discrepancy between the segments.

Malrotation and volvulus neonatorum

Volvulus always associated with malrotation

Two presentations
Acute:bilious vomiting(metabolic acidosis) The volvulus may compromise blood flow leading to ischemia hence tender rigid abdomen

We fear from massive loss of small intestine if neglected…he may not survive…or the lesser catastrophe is the SHORT GUT SYNDROME

Chr: chr intmt abd pain, constipation.

DOUBLE BUBBLE SIGN

20120609-161229.jpg

Normally SMV IS ON THE RIGHT. IF THE REVERSE HAPPENS, SUSPECT MALROTATION.(BY U/S!!!!!)
DILATED STOMACh AND DUODENUM WITH TWISTING OF THE MIDGUT LOOP: applepeel, twisted ribbon, corkscrew

20120609-161536.jpg

20120609-161545.jpg

20120609-161555.jpg

Do ladds procedure:
Untwist
Divide( ladds band)
appendectomy

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