Pattern of joint involvement:
-Distal interphalangeal joint (DIP) is involved in OA, psoriatic arthritis and gout.
-Proximal interphalangeal joint (PIP) and metacarpophalangeal joints (MCP) are involved in rheumatoid arthritis.
-First metatarsophalangeal (MTP) is involved in gout.
-Sacroiliac (SI) joint is involved in ankylosing spondylitis.
-Knee joint is involved in OA.
-Bilateral symmetrical joint involvement— RA
-Asymmetrical joint involvement (also usually bigger joints)—seronegative arthritis.
-Pain increased with activity, relieved by rest—mechanical arthritis.
-Pain worse with rest, improved by activity—inflammatory arthritis.
-Morning stiffness for more than 1 hour, relieved by activity indicates RA.
-Fleeting arthritis—Rheumatic fever, gonococcal arthritis, others (SLE, Lyme arthritis, meningococcal arthritis, drug reaction or serum sickness, IBD, Whipple’s disease).
#Rheumatology
-Distal interphalangeal joint (DIP) is involved in OA, psoriatic arthritis and gout.
-Proximal interphalangeal joint (PIP) and metacarpophalangeal joints (MCP) are involved in rheumatoid arthritis.
-First metatarsophalangeal (MTP) is involved in gout.
-Sacroiliac (SI) joint is involved in ankylosing spondylitis.
-Knee joint is involved in OA.
-Bilateral symmetrical joint involvement— RA
-Asymmetrical joint involvement (also usually bigger joints)—seronegative arthritis.
-Pain increased with activity, relieved by rest—mechanical arthritis.
-Pain worse with rest, improved by activity—inflammatory arthritis.
-Morning stiffness for more than 1 hour, relieved by activity indicates RA.
-Fleeting arthritis—Rheumatic fever, gonococcal arthritis, others (SLE, Lyme arthritis, meningococcal arthritis, drug reaction or serum sickness, IBD, Whipple’s disease).
#Rheumatology
Differential diagnoses of Nephrotic Syndrome:
1-Acute glomerulonephritis
2-Congestive cardiac failure
3-Cirrhosis of the liver
4-Hypoproteinemia due to malnutrition or malabsorption.
#Renal
1-Acute glomerulonephritis
2-Congestive cardiac failure
3-Cirrhosis of the liver
4-Hypoproteinemia due to malnutrition or malabsorption.
#Renal
•What is the most common cause of nephrotic syndrome in children and adult?
-Most common cause in children is minimal change glomerulonephritis,
-The most common cause in adult is membranous glomerulonephritis."White".
-FSGS is the most cause in black adults.
#Renal
-Most common cause in children is minimal change glomerulonephritis,
-The most common cause in adult is membranous glomerulonephritis."White".
-FSGS is the most cause in black adults.
#Renal
•What is the blood pressure in Nephrotic syndrome?
-Usually blood pressure is normal, even low. If there is hypertension, usually it is secondary to underlying disease like SLE with renal involvement, polyarteritis nodosa, diabetic nephropathy or terminal stage of nephrotic syndrome.
#Renal
-Usually blood pressure is normal, even low. If there is hypertension, usually it is secondary to underlying disease like SLE with renal involvement, polyarteritis nodosa, diabetic nephropathy or terminal stage of nephrotic syndrome.
#Renal
Complications of Nephrotic syndrome:
In addition to doctor's lecture:
-Hyperlipidemia leading to atherosclerosis.
-Oliguric renal failure.
-May cause bilateral pleural effusion, pericardial effusion.
-Loss of thyroxin binding globulin, that causes low FT3 and FT4 which leads to hypothyroidism.
-Loss of transferrin and iron, resulting in iron deficiency anemia.
-Loss of vitamin D binding protein, leading to osteomalacia.
#Renal
In addition to doctor's lecture:
-Hyperlipidemia leading to atherosclerosis.
-Oliguric renal failure.
-May cause bilateral pleural effusion, pericardial effusion.
-Loss of thyroxin binding globulin, that causes low FT3 and FT4 which leads to hypothyroidism.
-Loss of transferrin and iron, resulting in iron deficiency anemia.
-Loss of vitamin D binding protein, leading to osteomalacia.
#Renal
•Causes of puffy face:
-Renal cause nephrotic syndrome, acute GN
-Myxedema
-Cushing’s syndrome
-SVC obstruction
-Angioneurotic edema
-Hypoproteinemia
-Congestive cardiac failure in advanced stage
-Alcoholism
-Acromegaly.
#Renal
-Renal cause nephrotic syndrome, acute GN
-Myxedema
-Cushing’s syndrome
-SVC obstruction
-Angioneurotic edema
-Hypoproteinemia
-Congestive cardiac failure in advanced stage
-Alcoholism
-Acromegaly.
#Renal
•Causes of glomerulonephritis with low complement:
-Post-streptococcal glomerulonephritis
-Lupus nephritis
-Infective endocarditis
-Cryoglobulinemia
-Mesangiocapillary glomerulonephritis (90% in type II and 70% in type I).
#Renal
-Post-streptococcal glomerulonephritis
-Lupus nephritis
-Infective endocarditis
-Cryoglobulinemia
-Mesangiocapillary glomerulonephritis (90% in type II and 70% in type I).
#Renal
In CKD:
-Osteomalacia is secondary to deficiency of 1, 25-dihydroxycholecalciferol as kidney is unable to convert 25 hydroxycholecalciferol to 1,25 dihydroxycholecalciferol, due to deficiency of 1 α-hydroxylase enzyme.
#Renal
-Osteomalacia is secondary to deficiency of 1, 25-dihydroxycholecalciferol as kidney is unable to convert 25 hydroxycholecalciferol to 1,25 dihydroxycholecalciferol, due to deficiency of 1 α-hydroxylase enzyme.
#Renal
In CKD Bone diseases (renal osteodystrophy):
-Osteomalacia (or ricket called renal ricket)
-Osteoporosis
-Osteosclerosis (in vertebral body, giving rise to Rugger Jersey spine)
-Osteitis fibrosa cystica.
#Renal
-Osteomalacia (or ricket called renal ricket)
-Osteoporosis
-Osteosclerosis (in vertebral body, giving rise to Rugger Jersey spine)
-Osteitis fibrosa cystica.
#Renal
-End stage renal disease or failure (ESRD) is a stage when renal replacement therapy is compulsory either dialysis or renal transplantation, without which death is likely.
#Renal
#Renal
•Poor prognostic indicators in glomerular disease:
•Male sex
•Hypertension
•Persistent and severe proteinuria
•Elevated creatinine at time of presentation
•Rapid rate of decline in renal function •Tubulo-interstitial fibrosis observed on renal biopsy.
#Renal
•Male sex
•Hypertension
•Persistent and severe proteinuria
•Elevated creatinine at time of presentation
•Rapid rate of decline in renal function •Tubulo-interstitial fibrosis observed on renal biopsy.
#Renal
What are the signs of severe AR?
1-Prolonged EDM
2-A2 absent
3-Presence of left ventricular 3rd heart sound
4-Presence of Austin Flint murmur
5-Signs of LVF
6-Signs of enlarging heart.
#Cardiology
1-Prolonged EDM
2-A2 absent
3-Presence of left ventricular 3rd heart sound
4-Presence of Austin Flint murmur
5-Signs of LVF
6-Signs of enlarging heart.
#Cardiology
•To diagnose AR, remember the formula of 3:
-3 pulse: Collapsing (water hammer), dancing carotid and capillary pulsation.
-3 BP: Rise of systolic, fall of diastolic and wide pulse pressure.
-3 murmur: Early diastolic murmur, Austin Flint murmur and ejection systolic murmur.
#Cardiology
-3 pulse: Collapsing (water hammer), dancing carotid and capillary pulsation.
-3 BP: Rise of systolic, fall of diastolic and wide pulse pressure.
-3 murmur: Early diastolic murmur, Austin Flint murmur and ejection systolic murmur.
#Cardiology
•What is collapsing pulse, causes?
-In collapsing pulse, there is rapid upstroke and descent of pulse, seen by raising the arm above the head.
-Causes are:
1-AR (the most common cause)
2-Hyperdynamic circulation due to any cause
3-PDA
4-Rupture of sinus of Valsalva
5-Large AV communication.
#Cardiology
-In collapsing pulse, there is rapid upstroke and descent of pulse, seen by raising the arm above the head.
-Causes are:
1-AR (the most common cause)
2-Hyperdynamic circulation due to any cause
3-PDA
4-Rupture of sinus of Valsalva
5-Large AV communication.
#Cardiology
•What are the causes of high volume pulse?
1-Aortic regurgitation
2-Hypertension
3-Hyperdynamic circulation due to any cause (severe anemia, thyrotoxicosis, AV fistula, fever, Beriberi, pregnancy, P. disease etc.)
4-PDA.
#Cardiology
1-Aortic regurgitation
2-Hypertension
3-Hyperdynamic circulation due to any cause (severe anemia, thyrotoxicosis, AV fistula, fever, Beriberi, pregnancy, P. disease etc.)
4-PDA.
#Cardiology
•Why this is called Water hammer pulse?
-The name originated from a Victorian toy, consisted of a sealed tube, half filled with water and half being vacuum.
-Inversion of the tube causes the fluid to fall rapidly without air resistance and strike the end like hammer blow.
#Cardiology
-The name originated from a Victorian toy, consisted of a sealed tube, half filled with water and half being vacuum.
-Inversion of the tube causes the fluid to fall rapidly without air resistance and strike the end like hammer blow.
#Cardiology
•Are “high volume pulse” and “collapsing pulse” synonymous?
-Collapsing pulse is always high volume, but all high volume pulse are not collapsing..!
#Cardiology
-Collapsing pulse is always high volume, but all high volume pulse are not collapsing..!
#Cardiology
Prognosis in AS:
-If aortic valve isn't replaced, the onset of angina, syncope and dyspnea has been shown to correlate with an average time to death of 5, 3 and 2 years.
-Dyspnea has the worst prognosis followed by syncope then angina.
#Cardiology
-If aortic valve isn't replaced, the onset of angina, syncope and dyspnea has been shown to correlate with an average time to death of 5, 3 and 2 years.
-Dyspnea has the worst prognosis followed by syncope then angina.
#Cardiology
•What are the signs of Pulmonary HTN?
-Palpable P2
-Prominent ‘a’ wave in JVP
-Left parasternal heave (indicates RVH)
-Epigastric pulsation (indicates RVH)
-Loud P2 on auscultation
-Early diastolic murmur (Graham steel murmur due to PR).
#Cardiology
-Palpable P2
-Prominent ‘a’ wave in JVP
-Left parasternal heave (indicates RVH)
-Epigastric pulsation (indicates RVH)
-Loud P2 on auscultation
-Early diastolic murmur (Graham steel murmur due to PR).
#Cardiology