Cardiac Tamponade - References

Julian DG, Cowan J M, Mchenachan J M. cardiology. Edinburg:Elsevier; 2005
Fuster V, Alexander R W, O’Roucke A. Hurt’s The Heart. 11th edn. Newark:McGraw Hill;2004
Black JM, Hawks JH. Medical – Surgical Nursing: clinical management for positive outcomes. 7th ed. Saunders: Elservier;2004.
Lewis SM, Heitkempter MM, and Dirksen SR.Medical-Surgical Nursing: Assessment and management of clinical problems. 6th edn. Philadelphia:Mosby;2005
Posted in Medicine Notes | 23.8.04|By Vishaal ViewPost

Osteoarthritis

It is a functional joint disorder, characterized by progressive deterioration and breakdown of articular cartilage, mainly in weight-bearing joints and is essentially non-inflammatory in nature.
Note: Charcot joint is an extreme form of osteoarthritis seen in patients with neurological dysfunction in which there is rapidly destructive osteoarthritis, the production of loose bodies, severe subluxation and even dislocation of the joint.
Morphology: changes manifest morphologically as alterations in cartilage, synovium and bone…
Posted in Orthopedics Notes , Pathology Notes | 6.8.04|By Vishaal ViewPost

Normovolaemic Haemodilution

-performed either immediately before induction of anaesthesia or immediately after induction.
The suitability of the patient for this procedure must be established in advance.
The haemoglobin and haematocrit should be "normal"; eg Hb preferably above 12 g/100 ml.
The cardiovascular system must be such as to be able to compensate for the reduced oxygen carrying capacity.
Technique.
2 IV cannulae in different sites eg arms - one large (eg 12G) to collect blood, the other usual size for fluids and drugs.
Posted in Anesthesia Notes | |By Vishaal ViewPost

Meningitis

Bacterial meningitis is a devastating disease, if left untreated it results in death. Essentially it is an inflammation of the meninges. There are different types of bacteria that cause meningitis in neonates, elderly, and infants and children. Meningitis is rare between the ages of 20-60.
Neonates – Group B Strep, E. coli K1
Posted in Medicine Notes | 22.7.04|By Vishaal ViewPost

Dengue, epidemiology

The disease occurs everywhere in the tropics but is especially frequent India, Southeast Asia, Central America and the Caribbean. In 1927-28 there was a large epidemic in Greece in which approximately 2000 people died. Until recently, the infection had been very rare in Africa, except for the east coast (sporadic cases) and parts of the Sahel but the epidemiology of dengue is changing and we can expect the disease to increase in other parts of Africa. The disease is not stable in other parts of the world either. After an absence of 20 years, dengue virus type 3 broke out in the Caribbean in 1994. Dengue can occur as an epidemic, as was recently seen in parts of Central and South America and in 1997 in the islands of the Pacific Ocean. The disease occurs more frequently in the rainy season. In 1998 there was a massive increase in the number of cases in Southeast Asia and South America. In Brazil alone a total of 234,828 cases were reported in the first 4 months of 1998 (almost as many as for the whole of 1997).
Posted in Medicine Notes | |By Vishaal ViewPost

Dengue, diagnosis

Clinical: biphasic flu-like syndrome with severe muscle pain and sometimes rash. Sometimes positive tourniquet (= Rumpel-Leede test) with DHF: petechiae appear after applying a sphygmomanometer to the upper arm. The sphygmomanometer is inflated to halfway between the systolic and diastolic blood pressure. The meter is left in place for 5 minutes. Afterwards one looks for petechiae in the crease of the elbow. If there are more than 20 in a 3 cm diameter circle, the test is positive. This indicates significant capillary fragility, thrombocytopenia or disturbed blood platelet function.
Posted in Medicine Notes | |By Vishaal ViewPost

Dengue - clinical course

The course of the infection may be asymptomatic, atypical, “classical” or can evolve to a haemorrhagic syndrome with or without shock.
Classical dengue fever begins fairly suddenly with fever, headache and sometimes lymphadenopathy. There is no splenomegaly. There is marked muscle pain (breakbone fever), especially in the back and in the extraocular eye muscles (pain behind the eyes when looking sideways). The course of the fever is typically in two episodes (biphasic fever). A rash may appear around the 3rd to 5th day in a minority of patients. After the fever has disappeared, recovery may be long and difficult.
Posted in Medicine Notes | |By Vishaal ViewPost

Viral haemorrhagic fevers

The prototypical viral haemorrhagic fever is Yellow Fever. Other less well-known fevers are Omsk Haemorrhagic fever (Siberia, transmission via hard ticks and via contact with muskrats), Kyasanur Haemorrhagic fever (Karnataka, India) and Crimean-Congo Haemorrhagic Fever (transmitted by ticks, infected blood and nosocomially). Not all viral haemorrhagic fevers are however arboviruses. Various Arenaviruses (Lassa, Junin and Machupo) and Hantaviruses can lead to haemorrhagic fever, but are transmitted by rodents (“rodent-borne”) and other small mammals. Filoviruses cause severe bleeding, and are thought to be transmitted via infected monkeys / apes and via nosocomial transmission. Even haemorrhagic smallpox existed, but there the transmission was aerogenic. Haemorrhagic measles occurs occasionally, but this is usually not classified as a viral haemorrhagic fever.
Posted in Medicine Notes | |By Vishaal ViewPost

Fever and thrombocytopenia

Low blood platelets occur in a large number of febrile illnesses, including:
Septicaemia, including Gram-negative bacteria, typhoid, leptospirosis and borreliosis
Rickettsioses
Arboviruses such as dengue or yellow fever;
Posted in Medicine Notes | |By Vishaal ViewPost

Antibodies

Human antibodies exhibit an enormous range (~108) of specificity’s. The genetic basis for this involves several factors:
A. VDJ recombination 1. the heavy chain of the immunoglobulin is made up of a variable (V), diversity (D), and junctional/joining (J) segment.
2. The gene possesses greater than 200 V, 20 D, and 6 J coding sequences.
Posted in Pathology Notes | |By Vishaal ViewPost

MHC/HLA serotypes

Class I antigens are found on all nucleated cells (3 gene loci: HLA-A, HLA-B, and HLA-C). Class II antigens are found on immunologic effector cells (e.g. macrophages, B cells, activated epithelial cells; 3 gene loci: HLA-DP, HLA-DQ, and HLA-DR) 1. Familial inheritance
a) Many alleles of class I and class II molecules are present at each locus on chromosome 6.
Posted in Pathology Notes | |By Vishaal ViewPost

Important cytokines in regulation of the immune response

Tags: Cytokines, Immunology
Posted in Pathology Notes | |By Vishaal ViewPost

Major properties of the innate and acquired immune response

Tags: Immunology, Immunity, Defense mechanisms
Posted in Pathology Notes | |By Vishaal ViewPost

Innate Immunity

Present in babies, and protective
Rapid in onset, but little precision.
No memory, “ knee jerk response”
Can however recognise articles as being foreign The ER “medical technician”
Macrophages – Very important, particularly in this early immune response
Phagocytosis – recognise and remove unwanted particles
Secrete lysozymes to break down and kill particles
Secrete interferon to activate anti viral mechanisms
Posted in Pathology Notes | |By Vishaal ViewPost

Adaptive Immune System

The specialists.
Able to individualise treatment to the actual situation, and are better prepared and much faster the next time. The adaptive system amplifies the immune response and enhances the innate system eg phagocytosis and complement
HLA/MHC Name tag system – indicates to the lymphocytes “please have a look at this particle, and see if its ok…..”
Like presenting wares at a market for the diverse T cells to look through
Posted in Pathology Notes | |By Vishaal ViewPost

Autoimmunity : Etiology

A. Results when the body fails to recognize the difference between "self" and "non-self" antigens or epitopes, and mounts an immunologic response to those antigens.
B. May be T cell or B cell mediated.
C. Of two types:
systemic, involving multiple foci Organ specific
Tags: Autoimmune
Posted in Pathology Notes | |By Vishaal ViewPost

Autoimmunity : Mechanisms of Induction of the Autoimmune State

A. Release of sequestered antigen-
A sequestered antigen is one that under normal conditions is not readily available for recognition by the immune system, even though it is present in the body. Release of sequestered antigens is often caused by tissue injury. When the antigens are released, normal immunologic response occurs, i.e. antibody production, but since these antibodies are directed against self-antigens, they are called autoantibodies.
Examples:
anti-sperm antibody following vasectomy anti-lens antibody following eye injury Sympathetic Ophthalmia anti-cardiac muscle antibody following MI anti-corneal antibody following contact lens trauma
Posted in Pathology Notes | |By Vishaal ViewPost

Autoimmunity: Some Examples Autoimmune Disorders

Systemic Lupus Erythematosus-Systemic
In this disease, autoantibodies are formed which include anti-DNA, anti-RNA, and anti-cardiolipin. The antibodies form complexes (immune complexes) with the antigens to which they are directed. These immune complexes can form anywhere in the body, including the kidneys, where deposition within the glomerulus can result in glomerulonephritis, and kidney failure. Also, formation of anti-cardiolipin antibody may result in a FALSE POSITIVE RPR, when doing reagin-screening tests for syphilis.
Clinical Features:
anemia
Posted in Pathology Notes | |By Vishaal ViewPost

Cluster Designation

Tags: CD, Cluster Designation
Posted in Pathology Notes | |By Vishaal ViewPost

Histology Review Part 1

submandibular gland (or sublingual but not parotid) ***Serous Demilune***
Be able to distinguish between mucous unit (lighter) and serous unit (darker)
kidney
simple squamous epithelium (parietal layer of Bowman’s capsule)
simple cuboidal epithelium (around the ducts)
Posted in Anatomy Notes | |By Vishaal ViewPost

Histology Review Part 2

bladder (or ureter) transitional epithelium (dome shaped and/or bi-nucleate cells)
trachea
ciliated pseudostratified columnar epithelium with goblet cells
also refered to as respiratory tract epithelium but do not write that name on the exam
epididymis
pseudostratified columnar epithelium with stereocilia
Posted in Anatomy Notes | |By Vishaal ViewPost