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