Clinical Medicine Exam 2

antigens

recognize the self

antibodies

recognize foreign invaders

T cells

highly specific to invaders

anaphylaxis

closes off your airway and is a medical emergency

anaphylaxis treatment

epipen and oxygen

immunodeficiency disorders

• b cell deficiency: increased susceptibility to bacterial infections

• t cell deficiency: increased susceptibility to viral / fungal / protozoal infections

• predisposes patients to opportunistic infections (infections most people can fight off)

acquired immunodeficiency syndrome

• progressive impairment of immune system caused by HIV

• stage of active infection

• a common opportunistic infection is kaposi’s sarcoma

AIDS

• diagnosed by presence of HIV antibodies in blood, CD4 count <200 cells/mm, and/or one or more opportunistic infections

• western blot test to confirm

AIDS treatment

• highly active antiretroviral therapy (HAART) is the current treatment of choice

• goal is to maintain immune system for as long as possible

pernicious anemia

• type of megaloblastic anemia caused by impaired absorption of B12

• B12 is needed for cognitive function

• diagnosis: schilling test

• macrocytes may have howell-jolly bodies

systemic lupus erythematosus (SLE)

• chronic inflammation of skin, joints, nervous system, kidneys, lungs, and other organs

• onset typically occurs in women of child-bearing age (affects women more than men)

• raynaud’s phenomenon (raynaud's as a symptom rather than the disease itself) and hair loss are common

SLE diagnostic criteria

• butterfly rash on face

• positive antinuclear antibodies (ANA) are definitive for lupus

raynaud’s disease

• Chronic spasm of peripheral arterioles constricting and compressing circulation

• Most frequently seen in young women

• Exposure to cold leads to balancing of fingertips, possible cyanosis, and then redness

• Does not appear above metacarpophalangeal joins and does not affect thumb

• Usually resolves spontaneously after applying warmth

Seronegative Spondyloarthropathies

inflammatory rheumatic disease with negative RF factor (seronegative) but often associated with HLA-B27 gene

juvenile arthritis

migrognathia (receding chin) is characteristic

multiple sclerosis

a demyelinating disease, diagnosis of exclusion until plaques / lesions appear on MRI

myasthenia gravis

• a chronic progressive neuromuscular disorder that gets worse with activity and has unexplained spontaneous remissions

• characterized by extreme muscle weakness without atrophy and progressive fatigue requiring rest

pituitary gland

the “master gland,” connects the nervous and endocrine systems by releasing hormones that regulate thyroid, adrenal glands, reproductive organs, growth and water balance

gigantism

rare hyperpituitarism prior to puberty

acromegaly

rare hyperpituitarism after puberty

hyperthyroidism: grave’s disease

exophthalmos (bug eyes) is characteristic, low TSH and high T4 are indicative

hypothyroidism

treated with hormone replacement for life

hypoparathyroid disease

common signs are bone pain / weakened bones (osteoporosis), kidney stones, abdominal pain, fatigue, depression, constipation, and hypercalcemia

cushing syndrome

excessive circulating cortisol levels due to hypersecretion of the adrenal cortex, a moon shaped face is characteristic

addison’s disease

partial or complete failure of adrenocortical function, bronzing of the skintone is characteristic

type i diabetes

autoimmune condition, abrupt onset before 30 yoa, little or no insulin being secreted

3 p’s of type i diabetes

poluria (frequent urination), polydypsia (excessive thirst), polyphagia (increased appetite)

type ii diabetes

most common form, gradual onset usually after 30 yoa, some pancreating function remains, poorly managed or untreated has significant complications

diabetic ketoacidosis

occurs when there is too much glucose and not enough insulin (a sweet, fruity breath smell is characteristic)

insulin shock and diabetic coma

occurs when there is too much insulin and not enough glucose

sinus rhythm

normal beating of the heart

the SA node

the natural pacemaker of the heart

right and left atrium

collect blood from veins

right and left ventricles

pump blood from heart into arteries

ecg / ekg

not definitive of certain diseases, you can have a normal EKG and still have a heart disease

cardiac catheterization

considered the gold standard of heart disease tests

diuretics

remove extra fluid and salt through urination, 1st line of defense for hypertension

beta blockers

slows heart rate, reduces force of contractions, decreasing renin release and sympathetic outflow, 1st line of defense for hypertension

calcium channel blockers

relaxes blood vessels and slows heart rate, can’t discontinue abruptly or angina (chest pain) may occur

ace inhibitors

relax and widen blood vessels, cough is a common side effect

digitalis glycosides

drug of choice for systolic CHF and atrial fibrillation

statins

lower LDL (bad cholesterol), works best if taken late in day

hypertension

chronic condition where the heart works harder to pump against increased resistance, most prevalent cardiovascular disorder in the US, elevated blood pressure does not necessarily mean hypertension

ischemia

not enough blood flow to the heart to keep up with oxygen demand

infarction

death of heart muscle

angina

chest pain, onset is caused by exertion (heart attacks occur at rest or exertion), diagnosis: pt history reveals exertional chest pain

myocardial infarct

occlusion of coronary arteries causing death of myocardial tissue, most common cause is coronary thrombosis

stenosis

valve does not open fully / narrowing of a valve, forward flow is obstructed

regurgitation

valve does not close fully, blood flows backwards

prolapse

valve bulges backwards, may lead to regurgitation

shock

life-threatening collapse of the cardiovascular system, lactic acid accumulates

peripheral artery disease

circulatory disorder involving narrowed arteries supplying extremities due to atherosclerosis (plaque buildup)

peripheral artery disease symptoms

intermittent claudication (severe cramping) that improves with rest, cold feet/legs (due to poor circulation), poor wound healing (also due to poor circulation)

infective endocarditis

inflammation of lining and valves, vegetations (infected masses) are indicative

pericarditis

acute or chronic inflammation of pericardium (enclosed sac around the heart)

cardiac tamponade

life-threatening compression of heart muscle and restriction of heart movement caused by blood or fluid trapped in pericardial sac

rheumatic fever

systemic inflammatory and autoimmune disease involving joints and cardiac tissue, generally preceded by strep

sepsis

life-threatening condition that occurs when body’s response to an infection becomes dysregulated and causes widespread inflammation, leading to organ dysfunction or failure, early intervention is the key to improved outcomes

possible causes of anemia

acute or chronic blood loss, decreased production of red blood cells, increased red blood cell destruction

anemia diagnosis

ferritin level (evaluating iron levels)

disseminated intravascular coagulation (DIC)

life-threatening disorder in which the body’s clotting system becomes abnormally activated throughout the bloodstream leading to excessive clot formation and severe bleeding

acute lymphatic leukemia (ALL)

most common childhood leukemia, one of the most curable childhood cancers

acute myelogenous leukemia (AML)

auer rods will be present in diagnosis

chronic myelogenous leukemia (CML)

presence of philadelphia chromosome in diagnosis

hodgkin’s lymphoma

reed-sternberg cells are present in biopsy of node

multiple myeloma

bence-jones protein in urine is indicative

venous thrombosis

• formation of a blood clot within a vein, remains at site of origin

• commonly occurs in deep veins of legs (DVT), pelvis, or arms

• symptoms: swelling, redness, warmth, pain, tenderness in affected limb

• primary concern is obstruction of venous blood flow

• may remain localized or develop into an embolus

embolus

• clot or other material that travels through bloodstream and becomes lodged in distant vessel

• common sites are pulmonary arteries (pulmonary embolism), brain, or other organs

• symptoms have a sudden onset depending on location (shortness of breath, chest pain, stroke)

• primary concern is blockage of blood flow to critical organs / tissues, can cause life-threatening organ damage or death