Multifactorial

The following diseases are considered multifactorial. This means that the person has a genetic predisposition for the disease but will not necessarily get the disease. These diseases can be avoided (sometimes not always) by avoiding the risk factors associated with the disease

Essential Hypertension in African Americans and Elderly population

Gout

Type 2 Diabetes

Coronary Artery Disease

Affective Disorders

Congenital Pyloric Stenosis

Vasculitis

3 types of vessels can get vasculitis:

Small vessels Vasculitis = arterioles, venoules, capillaries

These will always be type 3 hypersensitivity = Immune complex deposits in small vessel and activates compliment. C5a attracts neutrophils = get fibrinoid necrosis, damage to the small vessel = palpable purpura. (not a platelet issue but a small vessel vasculitis)

Muscular Arteries:

Think Polyarteritis Nodosa, Wegner's Granulomatosis, Kawasaki's Disease in Kids

Thrombosis = Infarction (no palpable purpura)

In Kawasaki's kids get coronary artery vasculitis, if it thrombosis they have an MI

Elastic Arteries:

Vasculitis of arch vessels like carotid artery and other arch vessels.

Injury = strokes

Absent pulses = sign of elastic artery vasculitis like in Takiyasu's disease

Disease Associations

Increased Reid Index = Chronic bronchitis (Reid Index = ratio of gland depth to total thickness of bronchial wall)

Apical Cavitary Lesions = Tuberculosis

Curschmann Spirals = Asthma 

Elevated Sweat Levels = Cystic Fibrosis

Enlarged Hilar nodes = granulomatous diseases (TB) or lymphoma or tumor

Stomach Acid and H2

H2 blockers:

Mechanism:

Reversible block of histamine H2 receptors = decreases H+ secretion by parietal cells

Uses:

Peptic ulcer, gastritis, mild esophogeal reflux

Issues:

The main drug you need to remember for boards is Cimetidine

Inhibits P-450 

Antiandrogenic effects = prolactin release, gynecomastia etc.

Decrease renal excretion of creatinine 

Osler Weber Rendu

What will you see?

These patients will have Iron deficiency anemia due to persistent GI bleeds.

They will have little red dots = Telangiectasia on the hands, in their mouth and throughout out their entire GI tract.

Autosomal Dominant

Dislocated shoulder

One outcome of a dislocated shoulder is:

Damage to the medial cord which will affect the Ulnar nerve.

The symptoms will include loss of the ability to adduct the thumb (move the thumb towards the middle digits). 

If the question mentions a shoulder dislocation, and loss of the ability to Adduct the thumb pick the answer that deals with the medial cord and or Ulnar nerve.

Gallstones

2 types:

Cholesterol Stones: (80% of all glallstones)

most are Radiolucent but 10-20% can be opaque

Causes = obesity, crohns, lots of babies, etc (Fat, Female, Fertile, Forty, Fart)

Pigment Stones (20% of all Gallstones)

Caused by patients with chronic RBC hemolysis, alcoholic cirrhosis, old age, biliary infection

Bleeding blood

Platelet Deficiency:

Can't form Temporary hemostatic plug

Signs and symptoms:

Bleeding Time prolonged

Bleeding from small vessels and superficial scratches won't stop

Petechiae

Ecchymosis / purpura (bigger petechiae)

Epistaxis = nosebleeds (most common sign of platelet disorder)

Coagulation Deficiency:

Can form the temporary hemostatic plug just fine = Bleeding time is normal

Can't convert the fibrinogen in the temporary plug to fibrin, so all they have is the temporary unstable plug which can be dislodged very easily

Signs and Symptoms: (normal bleeding time)

Late re-bleeding (bleeding stops with temp. plug but later plug is dislodged and bleeding starts again)

Menorrhagia 

Hemarthrosis = bleeding into joints / closed spaces

GI bleeds

Abduction & Adduction of digits

Muscles = interosseous muscles 

Innervated by Ulnar Nerve