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