Hypersensitivity Pneumonitis and myeloma Flashcards
acute
within 4-8 hr expsoure to antigen reoslving in 48hr
chronic
dyspnoea and fibrosis logn term low grade expsosure
sub-acute
porgressive dyspnoea and alveolitis
cx
mould
hot tub
air conditioners
mist
cotoon
flax
damp wood
coal
birds
etc
tx
imunosuppresion
avoid antigen
environmental control measures
over 10% of what cells show myeloma
plasma cell on tissue bone marrow aspirate and biopsy
smoulderign myeloma - pre cancerous - how long to check
every 3 months fro 5yr montorign fucntions and complciations
completed treament for myeloma how long to measure them
every 6 months for 3 years
renal failure tends to occur first
zoledronic acid what if not tolerated do you give next
disodium pamidronate then sodium clodronate
consider referral for dental assessment and treatment
bisphosphates lead to
blood flow disruption
decreased OC function and numbers via ibhition of cholesterol pathway and stimualte OC apoptosis
osteonecrosis of the jaw
Osteonecrosis develops in the jaw because this bone has a higher remodeling rate than other bones, making it more prone to the effect of bisphosphonates
precursor for myeloma what its called when you have raised paraproteins
Monoclonal gammopathy of undetermined significance (MGUS) is a blood condition that happens when plasma cells (a type of white blood cell) develop unusually in your bone marrow.
if not infection or inflammation
can transform into myeloma
side effect of bisphosphonates
oesphagitis
tolerance to nitrates common so need to take long gap to imporve tolerance so take isorbide mononitrate when
8am and 4pm
angina pectoris management
PECTORIS
aspriin and statin
sublingual GTN
BB or CCB
long acting nitrate like ivabradine or nicroandil
assessment for PCI/CABG
due to slow heart rate no obvious pathology
inferior MI as RCA taken out
