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Brainstem Death

 

Deep coma and absent respirations

Absence of   drug intoxications

                             hypothermia

                             hypoglycaemia

    `                       acidosis

                             electrolyte imbalance

 

Tests                 all brainstem reflexes absent

                              unreactive pupils

                              no corneal response

                              no vestibulo-ocular response

                              no gag

 

 

 

 

Drugs excreted in breast milk

 

Antiobiotics-aminoglycosides,sulphonamides,tetracycline,metronidazole

Anti TB-isoniazid

CNS drugs-narcotics,BDZ

Antithyroid-carbimazole, radioactive iodine

Anticonvulsants-phenbobarbitone,phenytoin

Anticoagulants-warfarin

Cytotoxics and high dose steroids

 

 

 

 

 

 

Blue sclera (MIXED)

M arfans

I mperfecta (osteogenesis)

XE pseudo (Xanthoma Elastica)

ED Ehlers Danlos

 

 

 

Back Pain: DISK MASS

D    Degeneration: DJD, Osteoporosis, Spondylosis

I      Infection: UTI, PID, Potts, Osteomyelitis, Prostatitis, 

       Injury/fracture 

S     Spondylitis, Spondyloarthropathies (rheum. arthritis, Reiters, SLE)

K    Kidney stones/infarction/infection (pyelo/abscess)

M    Myeloma, Metastasis from breast, prostate, lung, thyroid, kidney CA

A    Aneurysm ,Abdominal pain referred to the back (see acute abdominal pain)

S    Slipped disk, spondylolisthesis

S    Strain, scoliosis/lordosis
      Skin: herpes zoster.

 

 

 

Beta Blockers in heart failure

 

CIBIS 2        (cardiac insufficiency bisoprolol study)

                        landmark trial

                        studied bisoprolol in mild to moderate heart failure 

                        (highly selective B1 antag)

                        results      34% reduction in mortality

                                               44% reduction in sudden death

                                               20% reduction in hospital admissions

                        no evidence that it is good in severe heart faiilure

 

 

 

carvedilol       b blocker, a blocker, antioxidant

                               in class 2,3,4 (ejction fraction <35%)

                               also class 1,2,3 (ejection fraction <45%)

                               results    65% reduction in mortality

                                                     good for hypertension

                                                     reduced chest pain in angina

 

 

 

BROWN SÉQUARD SYNDROME

hemitransection of the spinal cord
ipsilateral loss of proprioception, vibration
-and fine tactile discrimination
contralateral analgesia + thermoanaesthesia
ipsilateral lower motor neurone signs at
-the level of lesion
ipsilateral upper motor neurone signs below
light touch + tactile location are usually
preserved because they are both crossed +
uncrossed
.

 

 

 

BARTTER'S SYNDROME:

Autosomal recessive. 

Reduced reabsorption of NaCl  in thick ascending limb of Henle 

causes metabolic alkalosis

volume depletion which increases aldosterone levels. 

 Often Hypomagnesemic. BP normal.hypokalemia

 weakness. 

B vitamin names
"The Rhythm Nearly Proved Contagious":

Thiamine (B1)
Riboflavin (B2)
Niacin (B3)
Pyridoxine (B6)
Cobalamin (B12)