CLUBBING-PATHOGENESIS PDGF

Megakaryocyte or platelet clusters, lodged in the peripheral vasculature of the digits, release platelet-derived growth factor (PDGF) and lead to the increased vascularity, permeability, and connective tissue changes that are the hallmark of clubbing.

Release of VEGF and PDGF occurred after platelet impaction and is enhanced by hypoxia. VEGF along with PDGF induces the pathological changes of digital clubbing.
Digital clubbing

From LUNG INDIAMalay Sarkar¹, DM Mahesh², Irappa Madabhavi^3
1 Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, India

Name reason for Potts spine

Pott disease, or Pott's disease, is a form of tuberculosis that occurs outside the lungs whereby disease is seen in the vertebrae.Tuberculosis can affect several tissues outside the lungs including the spine, a kind of tuberculous arthritis of the intervertebral joints. The disease is named after Percivall Pott (1714–1788), a British surgeon. The lower thoracic and upper lumbar vertebrae are the areas of the spine most often affected. The formal name for the disease is tuberculous spondylitis

S3,S4 HEART SOUNDS

S3 heart sounds
Pathological cause
1. left ventricular failure
2.mitral regurgitation
3.in heart failure s3 occurs with tachycardia

Physiological causes- young adults, pregnancy, athelets, fever


S4 HEART SOUND-
It is soft , low pitched , best heard with bell of stethoscope at the apex . It is always pathological and is caused by forceful atrial contraction against  a non complaint or stiff ventricle

1. left ventricular hypertrophy( due to HTN, aortic stenosis, HOCM). It cannot occur in atrial fibrillation .

referral from MCLEOD

ACUTE EXACERBATION OF COPD CRITERIA

ACUTE EXACERBATION OF COPD CRITERIA- referral from MURRAY AND NADEL

1. It is an acute event characterized by a worsening of the patients respiratory symptoms that is beyond normal day to day variations and leads to a change in medications

REFERRAL FROM MURRAY AND NADEL

ACUTE EXACERBATION OF ILD CRITERIA

ACUTE EXACERBATION OF ILD
1. worsening dyspnoea  over 2 to 4 weeks
2.new ggo's in HRCT
3. absence of infection or other overt causes of decline
 acute exacerbation is more common in RA than other CTD'S witha high early mortality 

MARKERS OF ILD

ILD CLASSIFICATION

 2013 American Thoracic Society (ATS)/ERS classification 
Update of the classification of idiopathic interstitial pneumonias

Major idiopathic interstitial pneumonias

Idiopathic pulmonary fibrosis

Idiopathic nonspecific interstitial pneumonia

Respiratory bronchiolitis-interstitial lung disease

Desquamative interstitial pneumonia

Cryptogenic organising pneumonia

Acute interstitial pneumonia

Rare idiopathic interstitial pneumonias

Idiopathic lymphoid interstitial pneumonia

Idiopathic pleuroparenchymal fibroelastosis

Unclassifiable idiopathic interstitial pneumonias

.ATS GUIDELINES OF TB DEFAULT AND RELAPSE

WHY FASCIAL PUFFINESS OCCURS FIRST IN RENAL EDEMA

ECG FEATURES OF DEXTROCARDIA

Pulsations in different areas- causes

Pulsations can be felt at the following areas.

Carotid pulsation 
1. Aortic regurgitation 2. Aortic aneurysm 3. Thyrotoxicosis 4. Fever 5. Anaemia

Suprasternal notch pulsations
 1. Hyperkinetic states- anaemia 2. Thyrotoxicosis, fever 3. Aortic regurgitation 4. Coarctation of aorta 5. Aortic aneurysm Pulsation at pulmonary area 1. Patent ductus arteriosus 2. Atrial septal defect 3. Ventricular septal defect 4. Pulmonary hypertension

Pulsation at Left parasternal area

1. Ventricular septal defect 2. Atrial septal defect 3. Epigastric pulsation 4. Right ventricular hypertrophy 5. Aneurysm of aorta 6. Transmission of aortic pulsation


Pulsations at the back

1. Coarctation of aorta 2. Pulmonary arteriovenous fistula

approach to patient with dysphagia

Cardiac border

 Surface anatomy of the heart
The right margin of the heart extends from the right 2nd costal cartilage to near the right 5th costal cartilage (at the 6th chondro-sternal junction). The left margin of the heart descends laterally from the 3rd intercostal space to the apex located near the midclavicular line in the 6th intercostal space. 

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