hello everyone a very very good morning to all of you am i visible and audible can you give me a minute to confirm if i'm clearly visible audible i will start the session ahead give me a minute to confirm uh if someone from the audience can see me and hear me clearly you can give me a thumbs up in the chat box so it will be clear to me that i'm clearly visible audible and i can start the session i guess yes i am so i am let me check it once again give me a minute hello yes so yeah so i welcome you all for today's session a very very refreshing good morning to all of you so from today i'm starting this live session series so daily i will come daily from today daily i will come live at the rate 9 00 a.m in the morning and we will study some of the high yielding topic of either pathopharma micro specially for the university exams of second prop ambient students so i welcome you all for the session i am dr priyanka sajdev here and today we are going to take a very important topic of cardiovascular system the systemic pathology uh that is rheumatic fever and dramatic heart disease believe me it's a very very important topic if you don't believe me why don't you see the university exam previous year question people stronger topic so i will provide you the previous year question papers of your university exams of the past five years or ten years that your seniors may have provided you so from this topic per se we are having four long question so long question can be as direct as defined dramatic fever describe it etiogenesis pathogenesis pathology complications everything or it can be an indirect clinical question so diagnosis is not given to you but reading the question you will come to the conclusion the diagnosis is dramatic fever reading to the clinical question you will come to the diagnosis that the diagnosis is dramatic fever so reading to the question the diagnosis so indirect clinical question can also come in your exam so nowadays whatever university you are belonging maybe you are belonging to jabalpur university maybe you are belonging to maharashtra whatever university you are belonging so i have compiled the question of all the important universities throughout the country i'm talking about this india so important questions are these only so these are the long questions so usually i have seen it may be a direct question dramatic figure dramatic heart disease describe everything about it or it may be an indirect clinical question so i will read the question in the end let me explain you first the session in the end we will have a look on these questions so whatever question coming in your exam it will be uh you will be able to solve it that that is the long question now have why don't have you you have a look on the short questions so short questions usually i don't know the pattern the marking scheme of your university per se so in some university the short questions may be of two marks maybe or three marks maybe of five marks the short one and the long one twenty mark whatever if it is a short question now you have to write at least one to two pages on it right short question and if it is a long question you have to write at least five pages on it so short question you may see the list of the short questions what coming so important questions will be jones criteria asked again and again ashkov nodules rheumatic cardinals pancreatis so at the end of the session you will get my notes and you will have a look on these questions and all these questions are covered in the session so you can read the questions in the end so let me start the session so everyone is here so thank you very much my dear students so those who are wishing me happy teachers today thank you very much i wish you a great success in your career as well as personal life and my blessings are always with you god bless you stay blessed and just you know shine with good marks and that is the only proud moment for me once you good get good marks in your university exams in your competitive exams it's you know it's a very happy moment for a teacher so make me proud of you with that moment so that is the only gift i'm asking to you so attend the sessions properly study properly work hard work smart and get good marks in all the exams of your life so that is the only wish i can do anyways let me proceed so let me start the session take care so we know heart have four chambers we can see the four chambers two oracles two ventricles in the heart we are having two walls can you see the two walls the mitral wall and the tracker's pit ball we are having two arteries and two wings the right are the arteries the blue are the mains you already know which artery which means from which chamber you already know the complete circle you know the right side impure blood the left side pure blood you know everything i guess tk that is the general now in the heart there are three layers there are three layers can you tell me the three layers of the heart endocardium myocardium pericardium the innermost is the endocardium which is shown by red color the middle one is the myocardium which is shown by black color and the outermost is the pericardium which is shown by blue color give me a thumbs up on this point so these are the three layers you can see the three layers i have labeled the three layers for you i guess you all can see now tell me one point i'm asking you this question can you tell me can you tell me the composition of the heart walls i'm talking about walls wants me which layer is it the walls contain endo or mayo or parry or all i'm asking you this is a question for you heart walls are made up of what which layer the complete heart have three layers i agree the complete hard ball have three layers you can see but i am asking you what is the ball the composition of the ball do you know anyone mukul yana prayanshi ektas tuthi medico animal so yes yes priyanji absolutely right it is endocardium so the walls have only endocardia not myocardium not pericardium so we divide the endocardium into two parts the endocardium which is present on the wall see the endocardium which is present on the walls is known as valvular endocardium and endocardium which is present on rest of the heart except walls the rest of the three-dimensional art it is known as mural endocardium so can i say endocardia is of two types the bulbuler and the mural first understand this term myocardium pericardium no further type give me a thumbs up on these points right shall i proceed ahead shall i proceed so with this knowledge we can start our topic the rheumatic fever and dramatic heart disease now listen my dear students listen do you know the difference between dramatic fever and dramatic heart disease now in your exam whatever dramatic is coming now you write the same answer no both of them are not same please understand rheumatic fever is the umbrella term it includes five diseases one two three four five one of them is rheumatic heart disease so if in your exam dramatic fever is asked you have to write the fun diseases but in your exam if rheumatic heart disease is asked you have to write that one only not the other four so please understand now in your exam the examiner are very smart they are asking you specific question you have to write the specific answer right so let me first teach you what is rheumatic fever rheumatic heart disease is a part of rheumatic fever so what is rheumatic fever now if long question the five mark question long question coming in your university exam or dramatic piranha you have to write your answer in these headings your answer should be in headings you know headings should have sub headings and skin flowcharts and diagram first of all write the definition in introduction then tell me the etiology then tell me the pathogenesis then write about the jones criteria then tell me what is the revision in the jones criteria these are important for viva also you all may be having specimen of this heart in your museum you all may be having i'm damn sure every college have museum specimen on the vegetations of the heart you may be having this so five hours picked any time it can go care the second thing describe all the five things under that these are the headings let me start now i'm going to tell you a beautiful story a beautiful story listen to the story so can you see this is a child a beautiful diagram of a child why i'm saying it is a child because rheumatic fever is a disease of childs not adults the child ages three to five years imagine this is a child i have drawn a rub diagram these are the tonsils of the child i guess everyone can see the tonsils of the child right inside the tonsils of the child the child have infection the tonsillitis pharyngitis by a bacteria the name of the bacteria is gas group a streptococcus gas learn as gas group a beta streptococcus bacteria this is the infection terms light is caused to the child by this bacteria so you will say what will happen it's very common the childs have tonsillitis we all have tonsillitis when we were kids right so it is very common in child so what will happen uh body will form antibodies against the bacteria these are the antibodies against the bacteria the humeral immunity will come and roll and these antibodies will bind with the bacteria antigen and body complexes will be formed and the bacteria will be killed you will see that it's very easy what's the problem there dramatic people cannot say our old the problem is that the antigen present on the surface of the bacteria the name of that antigen is m protein this bacteria the gas bacteria group a beta stratocast bacteria have a antigen on its surface the name of the antigen epitope is known as an protein the similar antigen is present on five organs of human body the five organs of human body the similar antigen mimicking making antigen you can say right so basically these antibodies will get confused they are actually formed against the bacteria but they will think that this is also bacteria because they have same antigen and protein as that of bacteria so these antibodies will bind with these five organs and cause damage to these five organs caused five diseases under five organs give me a thumbs up you got my point so see i have drawn beautiful diagram can you see antigen antibody reactions in the five organs in the five organs name the five organs which five organs two vital heart and brain heart and brain i learned like this number one heart number two brain so now don't think about our skin the third is the skin just below the skin heart of your brain just below the skin we have subcutaneous tissue and just below the secretary's tissue we have joints so can you name the five organs say like this heart brain skin cellulitis tissue and joints now you will never forget so these five organs have five diseases now please mind my words mind my words that these five diseases is not caused by bacteria bacteria is not causing the diseases the five diseases the fine diseases are caused by the antibodies you know the human own antibody so can we say these are auto antibodies these are killing these are binding with own antigen due to the mimicry due to the mimicry so these are autoimmune disease right so the five organs have five diseases so can you name the five diseases in the heart we have rheumatic heart disease in the heart we have rheumatic heart disease in the brain we have chorea syndrome scoria syndams korea in the skin we have erythema marginatum red red lesions are there it is the marginator in the subcutaneous tissue we have subcutaneous medulls small small reduce and in the joints the child have arthritis inflammation of the joint inflammation of the joint arthritis it is in multiple joints by polyarthritis and it is migratory in nature so the complete name is migratory poly arthritis so the five organ with the five diseases the complete five diseases together known as dramatic fever now can you define dramatic people for me i guess everyone got priyanshi kuldeep trisha mogul yana all the students give me a thumbs up everyone everyone means everywhere you got the pathogenesis what is dramatic fever can you define it for me in your exam so can i say it is a multi-system disease yes it is fight for different organs it is always post the gas bacteria infection that the the child will come to you you are a pediatrician the child will come with the parents they will say the child have sore throat and after two to three weeks the child have these five diseases that is dramatic you got my point it is non-supportive because bacteria is not causing it it is caused by the auto antibodies it is an inflammatory disease involving the systems so can i say it is an immunologically mediated system disease yes because it is caused by auto antibodies it is caused by gas bacteria so this is the definition don't learn the definition don't mug it up i mean just understand the concept if you understand the concept not describe in your own words you will get the marks in your university exam if you are describing it correctly in your own beautiful words right now coming on the pathogenesis as i have already told you it is an autoimmune disease so this is a child the child have group a beta streptococcus gas bacteria pharyngitis after that antibodies are formed the antibodies are auto antibodies which are doing cross reaction with the five organs right the five organs are in front of you in each organ one one disease so one organ one disease one organ one disease the five organs the five diseases together known as dramatic people can i say this theory the complete surely the complete flow chart it's the antigen present on the bacteria the same antigen is present on the five organs so the five organs are doing mimicry of the bacteria or you can say bacteria is doing military of the five organ antigen so it is known as molecular mimicry and because of this molecular military the antibodies got confused and they are cross reacting cross calculus actually they are formed for bacteria but they are reacting with these also so molecular mimicry and cross reactivity is the name given to this hypothesis everyone give me a thumbs up use those stuffs just now many people team red or blue henna you have to use their terms in your university exam so coming on jones criteria jones is a scientist who has discovered all this to get the great scientist he has given five major and five minor criteria to uh you know diagnose dramatic river so the five major criteria are the five diseases in the five modern i have already told you so the five major criteria what are the five major criteria who will tell me in the heart it is rheumatic heart disease in the brain it's the last fourier in the skin it's the marginal in the subcutaneous tissue it's subcutaneous and in the joints it is arthritis inflammation of the joint and multiple joints are involved that's why polyarthritis and migratory polyarthritis so these five diseases in five organ are the five major criteria take care we got it so you can see the fight one two three four five five major criteria right right now so the same you can see can you see in this diagram the tonsils of child inside the tonsil can you appreciate the pass the pus is caused by the bacteria plus is known as superasian it is caused by bacteria the gas bacteria and after having tonsillitis the child have these things the five major criteria so the same five criteria polyarthritis pancaditis nodules so these are the five criteria right now what are the minor criteria who will help me with the minor so we are having five minor also so belly but the child have tonsillitis can you see your tonsillitis it is a password infection so the child has fever also at that time with the tonsillitis we always have fever if it is bacterial so the child has fever but fever is a minor criteria fever is not major it is minor number two number two it's arthralgia please mind my words inflammation in the joint is known as arthritis so this one is major you got my point you got my point so shall i proceed what are thinking is asking them how the antibodies are acting against its own body uh so are they clear as i have told you these are the auto antibodies um actually on the antibodies are formed against some antigen in the antigens we have specific molecules which are known as epitopes so as i have told you the name of the epitope is and protein you guess bacteria this is the diagram of gas bacteria this is the nucleus of the bacteria it is group a beta-streptococcus bacteria on the surface of the bacteria there is an protein so antibodies are actually formed against this ant protein but five of the human organs i have told you which five organs these five organs also have m protein also have amp protein like the bacteria so actually antibodies formed against this but it is cross reacting against this it got confused that it is thinking it is also bacteria this theory is known as molecular mimicry and cross reactivity i guess you got it they care give me a thumbs up if you got it so i was teaching you the minor criteria the first my minor criteria is fever the second minor criteria is arthralgia that is pain not inflammation the third minor pattern is previous history of dramatic people demanding the fourth is three things in the blood are raised if you check the blood of the child three things will be raised number one esr will be more number two crp c reactive protein will be more and number three wbc count will be raised it is an infection because of bacteria we have increased wbc count so leukocytosis c reactive protein and esr one of the minor criteria and in in the five major criteria one of them is heart whenever heart is involved there are changes in ecg ecg so whenever you do ecg of the child in the institute you have pq rst it is prolonged pr interval so these are the five minor criteria i will help you in rising five major five minor don't worry please understand first so these are the five major these are the five minor i will help you in revising wait a minute let me teach you revised jones criteria then we will revise everything okay so this was the jones criteria jones criteria then what happened now one day one person challenged jones akiowa you are a pediatrician imagine you are a pediatrician and a child is coming to your clinic with the parents with the mother and the mother saying doctor my child have few of these symptoms the cardiac multisystem involvement is there few of these also right so you will ask the mother ask the parent does your child have tonsillitis few days back all these few days all all these few days back if the mother is saying yes my child also have tonsillitis two three weeks back through the child was having trouble so the diagnosis is crystal clear yes it's dramatic fever because it is fitting after the streptococcal infection the child is having all these scenarios right but if the mother is saying no my child don't have fruit pain and without food pain can you say if major and minor both are present but throat pain is not there so can you see this dramatic fever no we cannot say so these criteria are incomplete these criteria is now these criteria major magnets so this major and minor cannot prove that it is a rheumatic fever so revision came so we have revised the jones criteria in the revised zone criteria we have three things the major the minor the same five major no change minor one of them is removed we are having only four now which one is removed i will tell you so we are having four minor but we have include the third criteria the we cannot claim that it is dramatic people sanjay about you got it yes or no so it is the thing it is nothing you got it shall i proceed so guess criteria are added in the revised journey to 2016. criteria so the major are saying right the five major are same i'm not revising the same minor music one of them is removed that recurrent history of rheumatic fever fever is there arthria is there the three things in the blood are raised it is there and uh pr interval is increased on incidences there but recurrent history of rheumatic people is removed so we are having four minor or gas guesses sometimes what happen now the child has subclinical throat infections swab like in covet we are doing the throat swab now so do a throat swab and know the culture do the culture if it is true one you can do it right or take the blood of the child in the blood of the child check for auto antibodies the two type of antibodies anti streptolysin no antibody it is known as asot tighter or anti-dna's antibody so one of the gas criteria these are known as gas criteria so can you help me revising anyone among you in revised journal criteria any one of you are dopamine osama yana priyanshi mokul who will help me please help me uh so the jones criteria major minor and yes so tell me five major one two three four five tell me minor the four minor one two three four and tell me the guess criteria one two three so can i say five four three who will help me with five four and three so the five major in the heart it's rheumatic heart disease or pan cardiacs in the brain it's enamels korea tk in the joints it's a polyarthritis polyarthritis migratory polyarthritis in the skin it's erythema marginatum and in the subcutaneous tissue exceptions in the minor criteria we are having only four which four can you help me with the four minor it's fever it's fever it's arthralgia not arthritis it's arthralgia not arthritis right and the third one it's increase three things in the blood increase esr increase crp and increase wbc and increase pr interval on the ecg so that's it right in the gas criteria again we are having three number one do a throat swap and prove it throat swap color and culture it or see two antibodies nt aso antibodies that is anti streptolysin no you have an anti dna is antibody don't know say joey poo i want thumbs up from all of you everyone each and every person give me a thumbs up to indicate that the jones criteria the revised zones criteria fitted in your mind it's a patent question of the examiner in your bhaiva what is the difference between jones and revised jones what is the revision so you should tell the gas criterias are added otherwise major miners are almost saying give me a thumbs up that is a revision that is your patent question of the why if you are a second class student so we are having five major we are having four minor and we are having three guests tk in music kitten a how many how many are present in one child so that you can make the diagnosis that child is having rheumatic fever and you straight forward start the treatment how many no it is not the all five should be present here or four no it's not the case how many so listen my words if at least two major minimum two major are present now no need to see minor minor high and indian doesn't matter if at least two major at least two or more than two two three four five at least two major are present no need to look for minor if two major are present directly look for guest criteria one of the guest criteria is present any one of the guests diagnosis is true if two of the major are present but what if you will out of the pipe only one measure is present only one major is present so you have to look for the minor also so a bit one major at least should it should have two minor along with one yes you got my point so there are two possibilities either two major or one major one major plus two minor quarter point but with both of them guest should be present here also at least one guess criteria here also at least one guest right here at least one i'm using the word at least so this is how you can make the diagnosis give me a thumbs up here so some are absolutely right give me a thumbs up so the same thing is written in front of you so either two major or one major plus two minor but in both the scenario you should have at least one guess at least one guess so that is all about it i would like to ask you questions heart 8 disease currently dramatic heart disease out of the fight take care so the first question is in front of you write the answer in the chat box i want to see who is first and i want to see who is accurate take care what is the mechanism of dramatic fever who will tell me the answer is it cross reactivity with one of the androgenous antigen is it innocence by slander effect is it toxins secreted by the bacteria is it release of cytokines what is the answer so stuti very good you are the first and accurate to answer apart from which osama uh everyone is right now so the correct answer is here a it's molecular mimicry and cross reactivity we have already discussed diagrams tk so the answer is a this is the next question who will answer the next question is in front of you which of the following is not a major criteria now please not a major criteria i'm asking not a major criteria you know the five major criteria which of the following is not a major criteria the options are cardiac tests subcutaneous nodules increase aso aso title and arthritis arthritis so very good are they cares first one no stuti again the first one to answer and all the students osama it's not d no arthritis is major arthritis arthritis is but increased eso is a guest criteria neither major nor minor it is a gas criteria so i will go with c and you all are right it's c you got it the correct answer is uh do mistakes here the next question which of the following is not included in major criteria the same question which of the following is not a major criteria the four options are in front of you which is the following is not a major criteria yeah so pancarditis chorea subcutaneous pancreatitis is dramatic heart disease only don't get confused and high esr so what is the answer yes yes you all are right it's high esr it's high esr because high esr again it's minor criteria one of the minor right one of the minor pancreatitis i got uh priyans you got confused pancreatitis is the other name given to rheumatic heart disease so don't get confused i will teach you this so the correct answer is d and you all are right yes yes very good you all are right so this is the next question in front of you now don't get confused all of the following are major accept same question with different options question are maybe same which of the following is not a major read the four options very carefully migratory polyarthritis subcutaneous nodules i'm sorry i'm sorry migratory poly arthralgia subcutaneous nodules choreocarditis so what you will say what you so it is a major criteria don't get confused so the correct answer here is so you can see these all are pyou's i have taken from various competitive exams sneak pg fmg i know you all are second class students most of you i know university is one indicator the most important dramatic heart disease now mind in your exam of dramatic fever is coming you have to write all five if rheumatic heart disease is coming you have to write only this one right so my question is let me start rheumatic heart disease the heart medicare problem over here all the three layers of the heart are involved so heart have three layers endocardium myocardium pericardium so all three layers are involved endocarditis myocarditis and peripherals so basically it is known as pancara pancardarte carditas pandora all all the three layers are involved so in the heart we have pancaditis can i say pancaritis word yes the next point i got it you you got it yes the endo the myo the peri area all of them are involved i will teach you how they are involved you can see endocardium the walls are involved myocardium is involved pericardium is involved and everything is happening after the throat pain throat painkillers so this dramatic heart disease okay i will give you the details all the no this is going to be our master diagram the stored stroke diagram in which i will show you what will happen in endocardium i will draw here what will happen in my video i will draw here and what will happen in pericardium i will draw i will draw everything in this diagram at the end this will be our master diagram so this is the summary of summary so the next thing is the three layers are involved by whom i it is not caused by bacteria with the endocardium binding with the myocardium binding with the pericardium because of molecular mimicry and antigen antibody reactions due to auto antibodies the the three things are there endocarditis but it is everything is due to auto antibodies not by bacteria right i guess you got it jello endocardium is of two types at the beginning of the lecture endocardium the wallpaper is modular endocardium although rest of the heartbeat you will never forget see the two walls i have drawn small small nodules on the walls no dudes these nodules are known as vegetations ticket the nodules on the heart walls are known as vegetations vegetations are also known as vegetations are very okay one at the same thing the nodules over the walls kishnev and i introduced so describe them they are small yes they are multiple yes they are very soft firm and sterile so despite them so the vegetations are formed in four diseases one of them is rheumatic heart disease which i am teaching today the rest of the diseases i will teach in further my lectures so apart from rheumatic heart disease the vegetations are seen in infective endocarditis uh non-bacterial thrombotic and ovarian is nbte and lisbon sec endobaridis which is seen in sle we will study all these it is your syllabus only taken in vegetation with them rheumatic heart disease is one of them but compare the vegetations of rheumatic heart disease with others it may smallest to them that's why i have put this diagram the diagram out from problems only so this is the smallest one multiple hair they are firm they are soft and they are sterilized right others i will not teach today but some other day we will continue see these are the real diagrams again the diagrams from global c these are the vegetations i am talking about you can see this is called what you say uh the uh the balls the portion of the heart walls you can see it is the middle wall leaflet tkn so which walls are involved concept of their heart mechanism how many heart balls are there there are four walls so this is the left side this is the right side and uh these are the things you can see here we have material ball here we have aortic volt so mitral aortic on the left side here we have tracker speed ball here we have pulmonary wall so tracker speed and tannery on the right side so what is the mnemonic how they are involved the mnemonic is mutual matp never forget it's very important ncq also most common ball involved is mitral second most common aortic so left side are more involved as compared to right so material followed by aotea followed by practice pitch and followed by pulmonary pulmonary is least common involved give me a thumbs up on this yes goddamn dinosaur thank you so that is the heart walls and word heart walls so can you tell me the most common answer is mutter now mitral second most common answer is aotic the least common answer is pulmonary okay i agree with all involved the material involves common huawei the material involves possibilities the next point is really very difficult i guess only 50 of the students will understand what is the location of the vegetation on the wall understand i will try my best but only once i will not repeat it ah okay let me draw the material ball so this is the two leaflets of the middle ball meter one have two leaflets we know that now you can see this is oracle left oracle and this is left ventricle we can understand imagine my two hands are my two leaflets let me see can you see my hands yeah you can see my hands these are the two leaflets when the two leaflets open blood from the oracle comes in the ventricle and they close they open they grow they open they close blood is coming from the oracle and ventricle now the the ball have upper surface which is towards the atria lower surface which is towards the ventricle and the junction junction that is known as line of closure the junction is known as line of closure give me a thumbs up if you got it give me a thumbs up now my question to you vegetations are formed on these leaflets but we are upper surface lower surface junction you have three options or all of them tell me the location the location upper no lower no it is at the junction so the vegetations are formed at the junction i have drawn the small small vegetations for you i'm drawing here so they are formed at the junction can you see beautiful vegetations on the junction see here it is not on upper not on lower it's at the junction can you see i guess you can give me a thumbs up so the same thing is written here so the vegetations are formed along the line of the closure that is at the junction and due to the formation of the vegetation there is a deformity the name of the deformity is fish mouth or buttonhole what do you mean by fish mouth can you see this is the back of split ball appreciate this is one of the cusp this is another cut and appreciate at the junction these are the vegetations at the junction the line of the closure because of which this bicuspid ball is looking like a fish mouth have you seen a fish mouth a pouting fish mouth beautiful enough so it is looking like a fish mouth or you can say it is looking like buttonhole the same is shown here so looking like a fish mouth or buttonhole the name of the deformity this is all you have to write in your example take care so what we have learned what we have learned we have finished this portion valvular endocarditis my vegetation which are small which are multiple which are sterile and bland on the wall is the junction or the line of closure whatever you say the name of the deformity is fish mouth or buttonhole or button vegetation description man you have to draw the diagram give me a thumbs up that's all about vegetation so barbarian endocardium hogan the mural endocardium mural endocardium is rest of the endocardium the mural endocardium is rest of the endocardium patch what do you mean by mac patch you can see the red color the red color is the mural endocardium that is the rest of the heart the poorer heart nail sift a small portion of the endocardium will get wrinkled it will get wrinkled you know what i am talking i am talking about about a three dimensional image imagine a three-dimensional image of the heart the innermost layer is the endocardium so complete endocardium is not involved only the endocardium of the left oracle out of the four chambers only one chamber can do cardiovascular left oracle left our special catheter patch you have to learn the location so what is macallan patch it is a thick and rough and wrinkled patch which is formed again not by bacteria by auto antibodies where it is what is the location the exact location is in left oracle the posterior surface of the left particle just above the material so that is the location location so see in this diagram both things are shown this is mac you can see in the left oracle and these are the vegetations in the mitral wall in the tricuspid wall the vegetations are there so both the things of the endocardium is done we are done with endocarditis right congratulations out of the three things we are done one endocarditis is done the pollen are also the mural also [Music] see the myocardium here also we have modules but these nodules are not known as vegetation like endocardium these are known as ashkov ashkov nodules usm what is the granuloma have you studied general pathology chronic inflammation cells in front of you so these are granulomas let me zoom so here see i'm zooming this one this one is see so this is the diagram i will draw it for you rather so in the center you have net process which net process general pathology is five type of necrosis constant processing correlatory liquefactive and cases so this could be noid necrosis which in a process fibrinoid it is not cases like tb you bought the important day in the center we have fibrinoid concentrate surrounded by five type of cells out of which two are very important so the first type of cells are known as escorses which are giant cells having multiple nucleus these are the giant cells the red one ashcop cells these are known as ash corp cells ta ashkov cells are giant cells the second type of the cells are anti-aging anti-aging anti-echo cells and drawing with glucose few of the anti-ash causes few of you will remember what sometimes you are drawing a nucleus like a caterpillar and sometimes you are drawing the nucleus like a own so these are anti-h all of the blue cells are anti and tishkoff and dish obviously so you must know what what is the shape of the nucleus i'm saying both shapes are correct if you see from front it is caterpillar if you give lymphocytes we all know what are lymphocytes these all are lymphocytes plasma cells we all know what are plasma cells so yes so this is the diagram can you see the same diagram given in your books you can see the central fibrinoid neck process i appreciate the red desserts these one multinucleated these are ashkov and appreciate the antihop they call it this one is caterpillar nucleus and this one is owl eye huh give me a thumbs up why you are not responding am i live can you see me hear me give me a thumbs up whatever yeah so what are the five type of cells so in the center we have fibrinoid necrosis it is surrounded by five type of cells ash cough antihop lymphocyte plasma and fibroblasts neutrons are absent there is no neutrophil in the fibrinoid uh in the body right so what are estrogen actually both of them are macrophages they are modified so macrophages are modified both of them are modified macrophages one are giant cells and these have multiple nucleus this have only one nucleus but one nucleus is either all eye appearance or caterpillar appearance i guess you bought it does anyone have any difficulty in understanding so you can see can you tell me this cell i'm marking for you write down in the check box you've also said it this diagram this is the diagram of nodule this one is the necrosis the red cell forms a cell no one is writing what is the red cell come on tell me [Music] this one or this one the blue one though either owl eye or caterpillar so both of these are antihop right so ashkov and antis of like that you have to identify coming on the last pericardius last cheese have pericarditis we are done with endo we are done with my own the last thing is the pericarditis you know in the heart we have endocardia myocardium and pericardium endocardium so there is a space between myo and peri this space is known as pericardial space pericardial space we all know that it is present in all normal human beings in me you everyone this space contains a small amount of fluid which is known as pericardial fluid we all have this fluid but this fluid is watering in consistency it is cirrus watering constancy and it's in very small amount and is normal to have this fluid in our hearts so it is present in the space between myocardium and pericardium which is known rhodia rheumatic as disease so this fluid instead of being becoming watery thin watery consistency it becomes ready i am using the word hindi because it so can you see the is the threats in pathology is known as fibrinous the threats and pathologies known as fibrinous fibrinous so instead of water it becomes ready yes so give me a thumbs up so instead of watering so this disease is known as fibrinous pericarditis so in the pericardium we have fabulous pyruvate residues it's very easy to understand in the in the pericardium we have in the disease we have fabulous peripherals this appearance is known as bread and butter bread butter sandwich yes and the breakfast i usually take it and it's very delicious so what is bread and butter appearance yeah because in a bread butter sandwich we have two bread slice and in the center we have butter of course yes have you ever tried to separate the two slices of bread away from each other in a sandwich if not do it do it but the next time you eat the sandwich so javi is separate can you try you can see the threads of the butter you can see the threads the threads of the butter separating from you can imagine at least the threads of the butter now imagine the child is dead the child is having rheumatic heart disease dramatic fever and the child is dead and i am doing the post martin the autopsy of the child so what i will do i will take the heart out the child heart out in a tray i will take i will cut the cardio and separate it from the myocardium i want to see all three layers so see this is the scissor with the scissor in this diagram the first diagram this is all pericardium i'm cutting the pericardium and just below that there is myocardium i am separating so see beautiful diagram everyone see here this is myocardium on this side this is pericardium already separated it is looking like bread butter appearance now white is known as bread butter this is one slice of bread this is another slice of bread so one of the slices myocardium one of the slices is pericardium or the pieces of butter that is fibrinous pericarditis so we correlate this term with bread and butter so everyone give me a thumbs up no one will explain you these concepts no you will not forget yes process or pericardium to bring us pericarditis bread and butter that's it that's it if you explain it completely you will get full five marks in the wrong question so that all the things are drawn here please appreciate the good diagram beautiful see the diagram these two things are in the endo this thing is in the myo and this thing in the parry appreciate my pancarditis efforts in this diagram so this heart is showing pancarditis my master diagram and this is the summary give me a thumbs up we are done with the first first major the remaining four i will cover in some other lectures right so future me hum connected you can read by yourself if you have any doubt you can connect with me take care so this one i have super simplified for you which was the most difficult among the five packets of choice are not very difficult to understand anyways now let's have a look on the university exam question a 12 year joint pain again minor criteria and palpitations in the heart heart my palpitations have some valvular disease in the heart child have a upper respiratory infection three weeks back yesterday um so one of the major and two minor the one major is palpitation which is indicating heart involvement and two minor and guest criteria is given on examination subcutaneous not use slow supplement is not used or may get one more major we have got features tell me the organs involved tell me that your pathogenesis you can tell everything once the diagnosis is done you can tell it subscribe it is a previous exam question in university exams next question is micro complete series for second prof so you are a very vital candidate for getting gold medal in these three subjects i can guarantee i got it i can guarantee yours also take care of the next question eight-year-old child first of all brought to the clinic by the mother mother complaining of shifting joint pain that is migratory joint pain swelling over the knee joint that is arthritis arthritis and polyarthritis multiple joints involved fever that is minor criteria on inquiry the child have attack of swords the mother is saying yes based on this what is the diagnosis of course romantic favor enlist the hormones involved you know the five hormones pathogenesis you know molecular memory cross reactivity english the causes of the death the cause of the death is usually heart involvement traumatic heart disease that is the cause of the death defined dramatic people direct question we ask that short questions i'm not reading all of them you can do it you like my way of teaching the concept the university exam questions the mcqs these are previous year questions so take the age died of rheumatic fever on a topsy which is not formed which is not found on a toxic tell me the answer priyanshi radhika who will tell the answer osama is saying be very good osama so ashkov modules are seen mccallum patchy scene supremacy is not seen yes now you know the features antihop cells are what what are antihistas are they modified macrophages modified neutrophil modified b cell modified rbc i guess everyone knows the okay so you can do can tell me the most common ball involved in dramatic fever you know the mnemonic so in this way there are many questions i'm not solving all but i guarantee you can solve all so i can share my pdf so we have done this and these four you can do by yourself take care don't hesitate to ask your doubts on my personal contact number consider me as a mentor as a teacher right so consider me and you can ask your doubts directly maybe i'm late in replying because of the busy schedule but as soon as i find the time i will get back to you that is for sure maybe the same day or maybe after one two days but i will get back to you so that is my contact number it's 983032948 you can contact and you can share it with all medicals medicals i mean only mbbs students with your friends colleagues everywhere throughout the globe so anyone can connect to me the medical students and they can ask their dogs regarding their professional career regarding their studies and everything and the doubts actual dots in pathopharma micro tell me your college name university exam dates if comfortable to you i can help you with the planning thank you very much if you like the lecture don't forget to click on the like button before leaving share on your badge groups please it's a humble request these are the free lectures of course everyone should be benefited so please share on your bachelor's that something good is happening somewhere people are not aware of it and subscribe the youtube channel don't forget to click on the bell icon if you want to get notified every day see you all tomorrow 9 00 am again in the morning with the next topic see you bye bye study hard all the best and bye bye i'm ending the session thank you thank you happy teachers day thank you very much and i wish all my dear students a great success in their professional as well as personal life and uh wishing you the same and uh that's it all the best i wish you all shine with great results the beautiful results and the top in your exams in your university exams as well as in your competitive exams and be a good doctor before that be a good human being if you're a good human being obviously you'll be a good doctor good practitioner anyways bye bye study hard all the best i'm ending it