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Airway obstruction

??????????? Obstruction to airway can be present anywhere from the extrathoracic airways air to the small airways in the periphery of lung. Large extrathoracic airway obstruction can occur acutely as with aspiration of food or a foreign body or with angioedema of the glottis. An allergic history with a few scattered hives should raise the possibility of glottic oedema. Acute upper airway obstruction is a medical emergency more chronic forms can occur with tumors or with fibrotic stenosis following tracheostomy or prolonged endotracheal intubation. Whether acute or chronic the cardinal symptoms is dyspnoea and the characteristic sings an stridor and retraction of supraclavicular fossa on inspiration.

??????????? Obstruction of intrasthoracic airways can occur acutely and intermittently or can be present chronically with worsening during respiratory infection. Acute intermittent obstruction with wheezing is typical of asthma.

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Anaemia

??????????? Anaemia may be defined as a state in which the blood haemoglobin level is below the normal range for the patients’ age and sex. The causes of anaemia are Iron deficiency, deficiency of vitamin B12, deficiency of folic acid, hypoplasia of the bone marrow, invasion of bone marrow by malignant cells and peripheral causes like blood loss, haemolysis, hypersplenism etc. In anaemia there is decreased O2 carrying capacity of the blood. The clinical features are lassitude, fatigue, breathlessness on exertion, palpitations, pallor of skin and mucous membrane, throbbing in head and ears, dizziness, tinnitus, edema.

??????????? The commonest cause of anaemia is iron deficiency, which results from either loss of iron due to bleeding, an inadequate diet or malabsorption, hook worm infestation. Treatment of iron deficiency anaemia is key supplemental iron therapy taking foods rich in iron. The treatment of other causes of anaemia or depends upon the cause.

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ADDISON’S DISEASE

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Chronic adrenocortical insufficiency

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Causes:

  1. Autoimune – MC
    1. Sporadic
    2. PGA – I – Others are Autoimmune Polyendocrinopathy, Cadidiasis, Ectodermal dystrophy
    3. Schmidt’s Syndrome (Addison’s disease + Hypothyroidism)
  2. B/L adrenbal age : Anticoagulants, Open Heart surgery, Trauma, APLS
  3. Adrenoleuko dystrophy : X Linked perioxisomal disorder and with neurological and psychiatric symptoms
  4. Rare causes: Lymphoma, Metastatic carcinoma, Cocciodomycosis, Histoplasmosis, CMV (AIDS), Tuberculosis, Sarcoidosis, Hemochromatosis, Allgrove’s Syndrome

Symptoms & Signs:

  1. Weakness, Easy fatigability, Anorexia, Nausea, Vomiting, Diarrhea, Amenorrhea
  2. T Skin pigmentation increases, pressure area & nipples
  3. Hypotension and small heart
  4. ¯Na+, ­K+, ­ Ca2+, ­BUN
  5. Neutropenia, anemia, eosinophilia and lymphocytoma

Diagnosis:

¯ Plasma corisol an failure arise after corticotropis administration. ­ ACTH levels

Treatment : Steroid replacement therapy.

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Aortic valve stenosis

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Common Cause:

  1. Rheumatic aotic stenosis
  2. Congenital
  3. Degenerative falcific aortic stenosis (Serile)
  4. Atherosclerotic aortic stenosis (> 6 yrs)

Symptoms:

  1. Angina (life expectancy < 4 years)
  2. Dyspnoea (LVF < 2 yrs)
  3. Syncope (Life expectance < 3 yrs)
  4. Dizziness
  5. Sudden death (Complete heart block or atrial tachyarrythmias)

Signs:

  1. Ulses parvus et tardus (Slow rising small volume pulse)
  2. Hearing apex, Sy, ejection click.
  3. Carotid thrice
  4. Rough ejection systolic murmur in AA
  5. Radiating to Carotid apex
Investigations
  1. ECG : LVIA with strain, LBBB, CHB if calicification of valve extends to conducting system.
  2. Ext: Post sterotic dilataion of ascending aorta calcification of valve
  3. ECHO: Confirmatory

Cardiac catherisation : To assess severity

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ARTHRITIS

Arthritis means inflammation of the joints. It can be due to

    1. Infection – septic arthritis
    2. 2o to autoimmune disease – rheumatoid arthritis
    3. Degenrative process – osteoarthritis
    4. Crystal deposition – gout
    5. Dermatological conditions- Psoriatic arthritis

Clinical Features

??????????? Patients, presents with fever, with chills and rigors, joint pain, severe painful restriction of the joint movements. If untreated arthritis can lead to crippling deformity.

Treatment:

??????????? Antibiotics arthrocentesis, arthrodesis, arthroplasty.

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