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

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