13.02.08 AMU notes

Drugs in COPD

• • Anticholinergic inhaler

    • Ipratropium (Atrovent)

    • Tiotropium (Spiriva)

  • Beta-agonist inhaler

    • Salmeterol (Serevent)

    • Formoterol (Foradil)

  • Inhaled corticosteroid (gargle after use)

    • Beclomethasone (Qvar)

    • Fluitcasone (Flovent)

    • Ciclesonide (Alvesco)

    • Flunisolide (Aerobid)

    • Mometasone (Asmanex)

    • Triamcinolone (Azmacort)

    • Budesonide (Pulmincort)

  • Combination: Budesonide/formoterol = Symbicort

Miller Fisher syndrome

• • Rare variant of GBS

    • Accounts for approximately 5% of GBS cases

  • Manifests as a descending paralysis, proceeding in the reverse order of the more common form of GBS

  • Usually affects the eye muscles first

  • Presents with a classic triad:

    • Ophthalmoplegia

    • Ataxia

    • Areflexia

  • The ataxia predominantly affects the gait and trunk, with the limbs relatively spared

  • Anti-GQ1b antibodies are present in 90% of cases

Bartholin's cyst

• • Formed when a Bartholin's gland is blocked

    • Tubes which lead from the glands to the vulva

  • May develop to a Bartholin's abscess

  • If the infection is severe or repeated, a marsupialization may be required to stop further recurrences

Headache: Indications for a scan/investigation

• • Any one of:

    • Age >40

    • Witnessed LOC

    • Neck pain or stiffness

    • Onset with exertion

    • Arrived by ambulance

    • Vomiting

    • HTN

      • SBP >160

      • DBP >100

  • Document all these if negative

SAH

• • CT sensitivity

    • 95% in day 1

      • Esp. if within 6 hours

    • 50% day 7

  • Xanthochromia on LP sensitivity

    • 98% 12 hours - 2 weeks

    • 40% at 4 weeks

  • Sentinel headache

    • Only in <5% of cases

Notes

• • LRTI is often used as a synonym for pneumonia

    • But can also be applied to e.g. bronchitis, lung abscess

  • Useful renal books:

    • Pocket tutor of renal medicine

    • Brenner: Textbook of nephrology

  • UGIB => Rockall score