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12.12.13 Ward notes

Tricuspid incompetence
  • Causes
    • Rheumatic fever
    • Pulmonary HTN
    • Infective endocarditis
  • Murmur
    • Loudest on inspiration
    • LLSB
    • Radiates to the liver
  • Other signs
    • Liver pulsation
      • But cf AVM and hepatoma
    • Raised JVP

TPMT
  • Thiopurine methyltransferase
  • Used to metabolise thioprines
    • 6-mercaptopurine
    • Azathioprine
    • 6-thioguanine
  • Check levels before starting therapy
    • Low activity in 10%
    • Absent in 0.3%

Femoral bruits
  • Traube's 
    • "Pistol-shot" 
    • Aortic regurgitation
  • Duroziez's sign /murmur
    • "To and fro" bruit over the femoral artery resulting from manual pressure applied over the femoral artery while listening with the diaphragm of the stethoscope
    • Aortic regurgitation

Campbell de Morgan spot
  • AKA cherry haemangiomas, senile angiomas
  • Common, benign skin lesions of middle to older age, formed by proliferating, dilated capillaries and postcapillary venules
  • Cause remains unknown
  • Visual appearance:
    • 1-3 mm diameter macules which may become larger papules over time
    • Typical bright cherry red colour but can appear violaceous
    • They are non-blanching



Notes
  • Breathing and heart sounds
    • Inspiration => Right side
    • Expiration => Left side
  • Cannon A waves are INTERMITTENT
  • Split skin graft - Front of thigh, buttock
  • (Un)folding of the aorta pushes the carotids up => Visible pulsation in the neck
  • Tacrolimus = FK-506
  • Wide/narrow pulse pressure => AS / AR
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