Muscarinic antagonists
- Urinary incontinence
- Tolterodine, oxybutynin, solifenacin
- COPD
- Parkinson's
ITP - Acute
- more commonly seen in children
- equal sex incidence
- may follow an infection or vaccination
- usually runs a self-limiting course over 1-2 weeks
- Chronic
- more common in young/middle-aged women
- tends to run a relapsing-remitting course
Systemic sclerosis / Scleroderma - Limited cutaneous systemic sclerosis (lcSSc), or limited scleroderma
- 70% of SSc cases
- Affects only the face, forearms and lower legs up to the knee
- AKA CREST
- Diffuse cutaneous systemic sclerosis (dcSSc), or diffuse scleroderma
- 30% of SSc cases
- Involves also the upper arms, thighs or trunk
- May also affect internal organs
- Diagnosis
- Symmetrical skin thickening
- Raynaud's
- Nail-fold capillary changes
- Antinuclear antibodies
- Antitopoisomerase (e.g. anti-scl70)
- Anticentromere
- Anti-U3
- Anti-RNA polymerase
Knee injuries - Torn meniscus
- Twisting sporting injuries followed by delayed onset of knee swelling and locking
- Patient may develop "skills" to unlock the knee
- PCL rupture
- Tibia lies back on the femur and can be drawn forward during a paradoxical draw test
- ACL rupture
- High twisting force applied to a flexed knee
- Loud crack
- Rapid joint swelling
Notes - Common causes of urticaria
- Aspirin
- NSAIDs
- Opioids
- Penicillins
- Loss of corneal reflex - think acoustic neuroma
- Goitre
- Hashimoto's: Non-tender
- De Quervain's (subacute): Tender
- Subclinical hyperthyroidism => AF + osteoporosis
- Shagreen patch
- G's and C's raised in anorexia
- growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
- Tramadol => Lower seizure threshold in epilepsy / With other drugs lowering threshold (TCAs, SSRIs)
- Spiculated = Needles
- Spigelian hernia
- Hernia through the spigelian fascia (Aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally)
- Should be repaired because of the high risk of strangulation
- Chronic pancreatitis
- Previous episode of pancreatitis plus one of:
- Evidence of endocrine or exocrine insufficiency
- Evidence of fibrosis on CT (calcium deposits)
- Creon makes you constipated
- Behcet's: Oral ulcers, genital ulcers and uveitis. Also VTE.
- Preauricular lymph nodes are only a feature of viral or Chlamydial conjunctivitis
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