14.03.24 Revision notes

Muscarinic antagonists

    • Urinary incontinence

    • Tolterodine, oxybutynin, solifenacin

  • COPD

    • Ipratropium

    • Parkinson's

    • Procyclidine

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