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Cerebellar signs    Disdiadochokinesia

                    `             ataxia

                                   nystagmus

                                    Intention tremor

                                   Slurred speech

                                   Hypotonia

 

 

 

 

 

 

 

She looks too pretty try to catch her !

S caphoid

L unate

T riquetral

P isiform

T rapezium

T rapezoid

C apitate

H amate

 

 

 

 

 

COMPLEMENT DEFICIENCIES

INHERITED

C1 INHIB  -Hereditary angio-oedema

C1r            -SLE like syndrome

C1s            -Immune complex disease

C2               -SLE. Henoch Schonlein, Glomerulonephritis

C3               -Recurrent infections

C5-9            -Recurrent infections

 

ACQUIRED

Renal        -Mesangiocapillary GN-Low C3, normal C1,2,4

                  -Acute post strep GN   -Low C3,4

Collagen   -SLE -Low C3,4

                   -In active Rheum Arthritis-Levels may be increased

Liver          -In acute hepatitis C3,4 are low in first week, in chronic C3 remains low

 

 

 

 

 

 

Cardiac Catheterization (Normal Values)

 

R Atrium                     -1.5 to 0

R Vent                        18/ 0 to 2

Pulmon Art                18/8

Pulmon Wedge          4

L Atrium                     4

L Vent                        130/0 to 10

O2 Sat  venous         65-75%

O2 sat  arterial         96-98%

 

 

 

 

 

Causes of Clubbing

 

Thoracic        Bronchial carconoma

                             Chronic lung suppuration

                             Fibrosing alveolitis

                             Mesothelioma

 

Cardiac          Cyanotic CHD

                            Endocarditis

                            Atrial Myxoma

 

GI                        IBD

                            Cirrhosis

                            GI lymphoma

                            Coeliac disease

 

Rare                 Familial

                            Thyroid Acropachy

 

 

 

 

Constrictive Pericardirtis

 

TB

Radiotherapy

Malignancy

Following severe pericarditis

Connective tissue disease

 

 

 

 

Carbon Monoxide poisoning

agitation and confusion

Bullous lesions

Muscle necrosis

hypertonia

Acute Renal Failure

Hyperpyrexia

Vomiting

Headache

arrhythmias

 

 

 

 

 

Carcinoid syndrome
CARCinoid:
Cutaneous flushing
Asthmatic wheezing
Right sided valvular heart lesions
Cramping & diarrhea

 

 

 

Captopril  side effects
CAPTOPRIL:
Cough
Angioedema/ Agranulocystosis
Proteinuria
Taste changes
Orthostatic hypotension
Pregnancy contraindication/ Pancreatitis
Renal failure (and renal artery stenosis contraindication)/ Rash
Increased potassium
Leukopenia/ Liver toxicity

 

 

 

Consent/Refusal

 

Dr-Patient relationship should be founded on mutual respect

Pt should make own decision, based on information and support

consent should be informed, voluntary and competent

pt should know all the information

only withold info if it will harm pt

life saving Rx can be given without consent

Pt has the right to refuse rx

there is no minimum age for consent

Pt should be informed of all teaching practices

 

 

 

Cholinergics  effects
If you know these, you will be "LESS DUMB":
Lacrimation
Excitation of nicotinic synapses
Salivation
Sweating
Diarrhea
Urination
Micturition
Bronchoconstriction