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Diabetes insipidus
Published on 2012-05-24 02:00:00
Diabetes insipidus is a condition in which the body fails to concentrate urine appropriately resulting in the excretion of large volumes of dilute urine regardless of the body’s hydration status. > read more
Lithium
Published on 2012-05-22 02:55:00
Lithium is a drug with a narrow therapeutic window which is used predominantly in the treatment of bipolar disorder. > read more
Benign paroxysmal positional vertigo
Published on 2012-03-12 02:30:00
Benign paroxysmal positional vertigo (BPPV) describes a condition in which there is:Rotational Vertigo Provoked by turning head/change in position Lasts around 10-30 seconds Possibly with nausea Most patients are over 40 years of age Women > men (2:1)Aetiology – believed to be due to free-floating endolymph particles in semi-circular canal. Most cases (60-70%) are idiopathic. Secondary BPPV may be due to Head trauma (7-17% of all cases of BPPV) Viral (up to 15% of all cases of BPPV)Meniere’s [..] > read more
Hypertrophic cardiomyopathy
Published on 2012-03-09 04:00:00
Hypertrophic cardiomyopathy is an autosomal dominant cardiac condition characterized by marked left ventricular hypertrophy with a non-dilated ventricular cavity, and in around 20% of patients left ventricular outflow obstruction. It is the commonest genetic cardiac disease (incidence 1 in 500) and the commonest cause of sudden cardiac death in the young. Presentation may be: Sudden death Syncope Shortness of breath Angina Palpitations Clinical findings may include: Ejection systolic murmur If o [..] > read more
Metabolic acidosis
Published on 2012-03-07 06:59:00
Definition of metabolic acidosis: low pH and low PHCO3 Metabolic acidosis may be due to:Accumulation of acids (= high anion gap) orLoss of bicarbonate (= hyperchloraemic metabolic acidosis, normal anion gap) Anion gap = (Na + K) - (Cl + HCO3)The normal anion gap is 14-16 mmol/lCauses of a high anion gap metabolic acidosis: MUDPILESMethanol (formic acid)UraemiaDiabetic ketoacidosisParaldehyde (acetic and chloroacetic acid)IsoniazidIronInborn errors of metabolismGlucose 6 phosphate deficiencyLac [..] > read more
Glaucoma
Published on 2012-03-05 10:21:00
Glaucoma describes a range of disorders with a characteristic type of optic disc damage usually due to raised intraocular pressure.Upper limit of normal intraocular pressure is 21mmHg. 2 main divisions of glaucoma are: Open angle = chronic Closed angle = acute Open angle glaucoma Primary open angle glaucoma occurs in 1-2% of over 40s and over 4% of over 80s Patients are often asymptomatic – visual losses tend to occur late in the course of the disease and is often peripheral. Fundoscopy may re [..] > read more
Gout
Published on 2012-03-02 13:09:00
Gout is an inflammatory arthritis caused by monosodium urate crystals in and around joints. The most commonly affected joint is the first metatarsophalangeal joint. When this is affected it is called a podagra. Tophi may develop in chronic disease. The most important risk factor for developing gout is hyperuricaemia. Hyperuricaemia may be caused by: Urate overproduction: PsoriasisExcessive dietary purine intake Cytotoxics B12 Alcohol Urate underexecretion Renal impairment Diuretics Low-dose asp [..] > read more
Polycystic ovarian syndrome
Published on 2012-03-01 13:44:00
The definition for polycystic ovarian syndrome varies, but the one adopted by the RCOG is 2 of 3 of: Polycystic ovaries (12 or more peripheral follicles or ovarian volume >10cm^3) Oligo or anovulation Clinical and/or biochemical signs of hyperandrogenism (hirsuitism, acne, alopecia) Features associated with polycystic ovarian syndrome include: Polycystic ovaries Hirsuitism Acne Obesity (40-50% of patients) Subfertility Oligo/amenorrhoea Hypertension Acanthosis nigricansIncreased risk of Type 2 d [..] > read more
Cryoglobulins
Published on 2012-02-29 08:59:00
Cryoglobulins are immunoglobulins that precipitate at temperatures below 37 c and redissolve above 37 c. They are identified in the laboratory by storing clotted blood at 4 c for 7 days and looking for a precipitate. There are 3 types of cryoglobulinaemia: Type 1 cryoglobulinaemia Monoclonal, usually IgM Accounts for 10-15% of cases of cryoglobulinaemiaAssociated with Multiple myeloma Waldenstroms macroglobulinaemia CLL Features of type 1 cryoglobulinaemia include Raynaud’s Acrocyanosis Gangr [..] > read more
Liver abscesses
Published on 2012-02-27 07:59:00
Liver abscesses may be: Pyogenic (80% of liver abscesses in the developed world) Amoebic Fungal Presentation: FeverAbdominal pain/tenderness Nausea/vomiting Chest pain Weight loss Rarely: cough/hiccups from diaphragmatic irritationDiagnosis:US CT Bloods – raised ALP commonest finding on LFTs Management 2-3 weeks broad-spectrum IV antibiotics followed by 2-4 weeks oral antibiotics Percutaneous drainage if >3cm in size Surgical drainage if multiple/loculated abscessSmall print gem: most abscesse [..] > read more
Narcolepsy
Published on 2012-02-24 13:19:00
Narcolepsy is excessive daytime sleepiness, possibly accompanied by features such as: Cataplexy (=brief attacks of sudden loss of skeletal muscle tone and power, often in response to emotion)Irresistible sleep attacksHyponagogic hallucinations Sleep paralysis It is believed that narcolepsy with cataplexy is due to loss of hypocretin-containing neurons in the hypothalamus. Onset usually in teens/20s Male predominance Increased risk if a family member has the disorder Associations with HLA DQB1 St [..] > read more
Saddle nose deformity
Published on 2012-02-23 14:24:00
Causes of a ‘saddle nose’ deformity include: Trauma Wegener’s granulomatosis Congenital syphilis Relapsing polychondritis References Chauhan. S. and D’Cruz, S. Images in clinical medicine. Saddle nose deformity. N Engl J Med. 2007; 356(26): 2720. Paddock, M., Lynch, C. and Paska, L. Wegener’s granulomatosis in primary care. JRSM Short Rep. 2010. 1(7): 59.Riechelmann, H. and Rettinger, G. Three-step reconstruction of complex saddle nose deformities. Arch Otolaryngol Head Neck Surg. 2004 [..] > read more
Wegener’s granulomatosis
Published on 2012-02-22 12:54:00
Wegener’s granulomatosis is a small and medium vessel necrotizing granulomatous vasculitis which predominantly affects the upper airways, lungs and kidneys but can affect any organ system. Possible features include:Respiratory symptoms – 90%Cough Pleuritis Haemoptysis Rhinorrhoea Epistaxis Sinusitis Subglottic stenosis -20% Saddle-shaped nose Perforation of the nasal septum Glomerulonephritis – develops in 80% at some pointInvestigations: Biopsy Necrotising granulomatous vasculitis with ne [..] > read more
Obstructive sleep apnoea/hypopnoea syndrome
Published on 2012-02-20 13:25:00
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) is a condition in which a person experiences repeated episodes of apnoea/hypopnoea because of closing of the pharyngeal airway during sleep (NICE definition) Symptoms Excessive daytime sleepiness Snoring Morning headaches Nocturia Sexual dysfunction Impaired cognition Risk factors for OSAIncreasing ageObesity Male gender Enlarged tongue or tonsils Conditions associated with OSAHS Marfans Downs Acromegaly Hypothyroidism Diagnosis History Sleep s [..] > read more
Hypothermia
Published on 2012-02-17 12:58:00
Mild hypothermia: core body temperature < 35CSevere hypothermia: core body temperature < 28C Signs associated with moderate hypothermia include: Bradycardia, atrial arrhythmias Hypotension HypoventilationDilated pupils Hyporeflexia Signs associated with severe hypothermia include: Ventricular arrhythmias or asystole Coma Unreactive pupils Pulmonary oedema InvestigationsECGJ wavearrhythmias ABGMetabolic acidosisBloods FBC - ? thrombocytopenia due to hepatosplenic sequestration Coagulation – h [..] > read more
Pseudomembranous colitis
Published on 2012-02-15 11:54:00
Pseudomembranous colitis is an acute infective colitis which occurs when changes in the bowel flora allows overgrowth of clostridium difficile and thus production of its toxins (especially toxin A and B)PresentationWatery diarrhoea – may be bloodyFeverAbdominal painRaised WCCRisk factorsBroad-spectrum antibiotic use, especially:ClindamycinSecond and third generation cephalosporinsFluoroquinolonesCarbapenemParenteral nutritionDiabetesRenal failureLiver failureCystic fibrosisUpper GI surgeryMaln [..] > read more
Myocarditis
Published on 2012-02-13 11:14:00
Myocarditis is inflammation of the myocardium.Presentation is highly variable and includes:Prodrome of flu-like symptoms or gastroenteritis Chest painCollapse Heart failure Causes of myocarditis include:Viral Adenovirus Coxsackie Parvovirus HIV HCVBacterialStreptococcal Mycoplasma pneumonia SyphilisFungalDrugs Cocaine TCA DigoxinDiureticsAntibiotics – Cephalosporins, penicillin Dobutamine Other Sarcoidosis Wegener’s granulomatosisChurg-Strauss IBD SLE ThyrotoxicosisTrypanosomiasisSchistosomi [..] > read more
Prader-Willi syndrome
Published on 2012-02-12 03:03:00
Prader-Willi syndrome is an inherited disorder characterized by: ObesityHypotoniaHypogonadism Short stature Mental retardationIronically, despite being characterized by obesity, babies with Prader-Willi have feeding problems and fail to thrive in infancy. The classical phenotype of a patient with Prader-Willi Syndrome is: Obese Short stature Almond-shaped eyes Narrow bifrontal diameter Downturned angles of the mouth Small hands and feetStraight ulnar border of hands Prader-Willi Syndrome is caus [..] > read more
Acanthosis nigricans
Published on 2012-02-11 03:17:00
Acanthosis nigricans is characterized by velvety, brown-black plaques, typically located in the axilla and neck. It is associated with: Insulin-resistance: Diabetes Acromegaly Cushing syndrome Hypothyroidism PCOS Malignancy – especially gastric adenocarcinoma Other Primary biliary cirrhosisPrader-Willi syndrome Medications Glucocorticoids OCP Niacin ManagementTreat underlying cause ? retinoids References Higgins, S., Freemark, M. and Prose, N. Acanthosis nigricans: a practical approach to eval [..] > read more
Side effects of corticosteroid treatment
Published on 2012-02-10 02:38:00
Side effects of corticosteroid treatment include:Musculoskeletal Osteoporosis Fractures – 12% Avascular necrosis of femoral head (high doses) Proximal myopathyGastrointestinal Peptic ulcerationAcute pancreatitis Endocrine Weight gainDiabetes Adrenal suppression Hypercholesterolaemia/hyperlipidaemia Menstrual disturbances Skin Acne Skin bruising/thinning Hirsutism Other Sleep disturbance Mood disturbance Cataracts -15% Glaucoma HypertensionIncreased susceptibility to infection Adrenal suppressi [..] > read more
Polymyalgia rheumatica
Published on 2012-02-09 03:46:00
Polymyalgia rheumatica is an inflammatory rheumatic disease characterized by: Bilateral shoulder and/or pelvic girdle aching Morning stiffness >45 minutes duration Raised ESRSystemic symptomsLow grade fever Weight loss Average age of onset is >70. It is very rare in those males (3:1) People of north European ancestery more likely to be affected.There is evidence of a link to HLA DR4 Treatment Oral prednisolone – 15mg OD – tends to improve condition dramatically within days. Taper dose to [..] > read more
Sickle Cell Disease
Published on 2012-02-08 02:30:00
Sickle cell disease is an autosomal recessive condition caused by an abnormal form of haemoglobin, HbS, which polymerises into long crystals when it deoxygenates, resulting in the sickling of red blood cells. This abnormality is caused by a glutamine to valine substitution on the beta globin chain. Genotypes include:HbSS = sickle cell anaemia = commonest form in UK and most severe HbSC = SC disease = mild anaemia HbS beta thalassaemia trait Carriers are asymptomatic and have increased resistanc [..] > read more
Oesophageal carcinoma
Published on 2012-02-07 03:37:00
Oesophageal carcinoma has an incidence of 9.6/100 000 and a very poor prognosis – 5 year survival is less than 10%. 2/3rds of cases are in over 65s. Presentation tends to be dysphagia. In the UK the commonest type is adenocarcinoma.Identified risk factors for oesophageal adenocarcinoma include: Reflux/Barrett’s oesophagus Hiatus herniaObesity Diet lacking in fruit and vegetables Fatty diet Smoking Male gender Worldwide the commonest type of oesophageal cancer is squamous cell. It is especia [..] > read more
Lymphadenopathy
Published on 2012-02-06 03:00:00
Causes of generalized lymphadenopathyNeoplastic LymphomaleukaemiaInfective EBV CMVHIVTBToxoplasmosisMedications Allopurinol AtenololPenicillin PhenytoinQuinidine RheumatologicalRASLE SarcoidosisStorage diseases Gaucher’s disease Fabry’s diseaseCauses of local lymphadenopathyLocal infectionNeoplasia Small print gems: Virchow's node - left supraclavicular node associated with intraabdominal cancerSister Mary Joseph node - umbilical node associated with intraabdominal cancerReferences Bazemore, [..] > read more