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
Notes- 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
- AUTONOMIC NEUROPATHY in diabetes
- 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
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