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14.03.20 Placement notes

Cardiac decompensation in pregnancy
  • Mitral valve stenosis
    • Commonest cause of cardiac abnormality occurring in pregnant women
    • Esp. in countries with high incidence of rheumatic heart disease
    • Mid-diastolic murmur, esp. in left-lateral position
    • Can => AF (in 40%) => Rapid decompensation
    • Manage with balloon valvuloplasty
  • Aortic dissection
    • Esp. 3rd trimester
    • Tearing chest pain or syncope
    • May be hypertensive
    • Right coronary artery may become involved in the dissection, causing inferior myocardial infarct in up to 2% cases
    • Aortic regurgitant murmur may be auscultated
  • PE
    • Chest pain, hypoxia and clear chest on auscultation in pregnancy should lead to a high suspicion of pulmonary embolism

Neutropenic enterocolitis / Typhlitis
  • Necrotizing enterocolitis occurring primarily in neutropenic patients
    • "Typhlitis" = Neutropenic enterocolitis of the ileocecal region
  • Often in individuals with hematologic malignancies who are neutropenic and have breakdown of gut mucosal integrity as a result of cytotoxic chemotherapy
  • Medical emergency; Required urgent treatment

Coombs test
  • Direct
    • Wash RBCs
    • Add anti-human globulin (Coombs reagent)
    • If RBCs agglutinate they must have antibodies bound - e.g. in autoimmune haemolytic anaemia
  • Indirect
    • Take serum
    • Add to RBCs and check for agglutination
    • i.e. Checks for presence of anti-RBC antibodies in the serum - e.g. Pre-transfusion / Antenatal 

Dabigatran etexilate for the prevention of stroke and systemic embolism in atrial fibrillation
  • Non-valvular AF plus one of:
    • Previous stroke or TIA
    • Reduced cardiac output
    • NYHA 2 or above
    • Age 75 or older
    • 65 or older plus diabetes, coronary artery disease or high blood pressure

Causes of clubbing
  • C - Cyanotic heart disease
  • L - Lymphoma
  • U - Ulcerative colitis
  • B - Bronchiectasis / Cystic fibrosis / Empyema
  • B - Bronchogenic malignancy
  • I - Idiopathic pulmonary fibrosis
  • N - Neoplasms
  • G - Granulomatous diseases

  • Chondrodermatitis nodularis helicis
  • Norethisterone 5 mg tds can be used as a short-term option to rapidly stop heavy menstrual bleeding
  • Retrograde menstruation as cause of endometriosis
  • Caesarean section is the single biggest risk factor for endometritis
  • Haemorrheologic effect: Improves red blood cell deformability (e.g. pentoxifylline)
  • Pentoxifylline indications:
    • IC in PAD (only licensed indication)
    • Multi-infarct dementia
    • Peyronie's disease
    • Sarcoidosis
    • Peripheral neuropathy
    • Sickle cell
    • Alcoholic and non-alcoholic steatohepatitis
    • Endometriosis
    • Radiation-induced fibrosis
  • Amyand's hernia
    • Rare form of inguinal hernia (less than 1%) which occurs when the appendix is included in the hernial sac and becomes incarcerated
    • Symptoms may mimic appendicitis
    • Treatment consists of a combination of appendectomy and hernia repair
  • CHECK FOR TB before starting biologic immunomodulators
  • More than 80% of those with PSC have ulcerative colitis
  • Complications of Transurethral Resection: TURP
    • T ur syndrome 
    • U rethral stricture / UTI
    • R etrograde ejaculation
    • P erforation of the prostate
  • Acute pancreatitis is known to precipitate ARDS
  • Renal adenocarcinoma 
    • Most common renal tumour
    • Typically affect the renal parenchyma
    • May produce cannon ball metastasis in the lung which cause haemoptysis
  • Increased risk of graft loss in HLA mismatch in renal transplant:
    • HLA-DR : x5
    • HLA-B : x3 
    • HLA-A : x2