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