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Anion Gap Acidosis:

"Mudpiles"

M - Methanol
U - Uremia
D - DKA/AKA
P - Paraldehyde/phenformin
I - Iron/INH
L - Lactic acidosis
E - Ethylene glycol
S - Salicylates

 

 

 

Normal Gap Acidosis:

HARDUP

H - Hyperalimentation/hyperventilation
A - Acetazolamide
R - RTA
D - Diarrhea
U - Ureteral diversion
P - Pancreatic fistula/parenteral saline

 

 

Angioplasty trials

NEJM                 is primary angioplasty better than thrombolysis ?

                               angioplasty    user dependant

                                                                 takes time

                                                                 increased risk of dissection

                                                                 fewer haemorrhagic complications

                                                                 earlier revascularization

                              has a 30% risk of restenosis

                              risk decreased by stenting

                              risk also decreased by antiplatelets (ie 2b/3a antagonist)

 

RITA 1              (randomized intervention treatment of angina)

                             compared PTCA with CABG

                             both were equally effective

 

RITA 2              medical vs surgical treatment (1018 patients)

                             early PTCA benefits patients with angina

                             but hasa a alightly increased mortality

 

 

 

 

Complications of Ankylosis Spondylitis

 

Anterior uveitis

Atlanto axial subluxation

Aortic root dilatation

Aortic regurgitation

AV conduction defects

Amyloidosis

Apical fibrosis

Achilles tendinitis

 

 

 

side effects of amiodarone

 

photosensitivity

skin rash

hpo/hyperthyroidism

corneal deposits

neuropathy

testicular dysfunction

nausea

interacts with warfarin

 

 

 

AUTOSOMAL DOMINANT

polycystic kidney ch16
monogenic hypercholesterolaemia ch 19
neurofibromatosis ch 17
Huntingtons chorea ch 4
Marfans synd
arachnodactyly
Von Willebrandsdystrophia myotonica
hereditary motor+sensory neuropathy I+II
congenital spherocytosis
multiple polyposis coli

 

ACE trials

 

CONCENSUS     enalapril in class 4 CCF

                                    31% reduction in mortality at one year

                                     improves symptoms as well

 

SOLVD                    enalapril in asymptomamatic heart failure

                                    in patients with EF <35%

                                    reduced rate of progression of symptoms

                                    no effect on overall mortality

                              

 

SAVE                       captopril 3-16/7 post mi

                                    19% reduction in mortality

                                    decreases progression to severe CCF

 

 

AIRE                        ramipril post mI

                                    26% reduction in mortality  

                                  

 

 

ELITE                       evaluation of losartan in the elderly

                                     in patients with CCF

                                     losartan had a lower mortality than captopril    

 

 

 

 

ASCITES-causes

primary liver disease
Budd-Chiari synd.
abdominal malignancy
infection esp. TB
pancreatic ascites
chylo ascites due to lymphatic block
cardiac cirrhosis
hypothyroidism
nephrotic syndrome

 

 

 

 

APLASTIC ANAEMIA-drug causes


-Chloramphenicol,Sulphonamides
-Phenylbutazone,Oxyphenbutazone,Gold
-Penicillamine
-indomethacin
-carbimazole,thiouracils
-Phenytoin
-Chlorpromazine,dothiepin,phenothiazines
-Arsenicals,chloroquine
-Thiazides,acetazolamide
-Chlorpropamide

 

 

 

AORTIC REGURGITATION-causes

congenital bicuspid valve
calcific disease
rheumatic disease, rheumatoid disease
infective endocarditis
Marfan's synd.,Reiter's synd.
ankylosing spondylitis
syphilis - seagull murmur
hypertension
aortic dissection
aortic root aneurysm
deceleration injury
prolapse into a VSD

 

 

 

Eponymous signs in Aortic Regurgitation

 

Quincke's-     Nail bed fluctuations

Corrigans_     Collapsing pulse of carotid

De Musset's- Head nodding

Durozier's-     Femoral bruits

Austin Flint-  Mitral flow murmur

Argyll Robertson pupils-in syphillis

 

 

 

 

 

 

ATRIAL SEPTAL DEFECT-ostium secundum

pulmonary hypertension in 10%
symptoms in late middle age
palpable right ventricle
systolic flow murmur pulmonary area
wide splitting 2nd heart sound
soft diastolic tricuspid murmur
long PR interval,RBBB, right axis deviation
+mitral stenosis=Lutembacher's syndrome
assoc. with mitral valve prolapse
surgical correction if pulmonary flow > twice systemic

 

 

 

ATRIAL SEPTAL DEFECT-ostium primum

5-10% of ASDs
75% have cleft in anterior cusp of mitral
valve - mitral regurg
left axis deviation and RBBB

 

 

 

ANTITHROMBIN III DEFICIENCY

autosomal dominant
homozygotes probably die in infancy
40-60% normal levels of AT III
repeated venous thromboses, early adulthood
presentation during pregnancy for example
-risk per pregnancy = 70%
-SC heparin through pregnancy
AT III concentrate for surgery and childbirth

 

 

 

ACUTE INTERMITTENT PORPHYRIA-features

autosomal dominant 
most common in Sweden
attacks common in late pregnancy + puerperium
acute attacks characterised by
colicky abdo pain 95%,muscle aches 50%
psychological symptoms 50%
vomiting80%,constipation75%,diarrhoea10%
SIADH, peripheral neuropathy 66%
dec. tendon jerks 50%
inc. BP+HR, siezures 10%
proteinuria 10%
many precipitating factors
urinary porphobilinogen excretion raised
between attacks

 

 

Cause of a Positive ANA

Collagen vascular disease

Chronic liver disease

Hashimotos, Myasthenia gravis

Pernicious anaemia

TB, leprosy

Ulcerative Colitis

Diffiuse pulmonary fibrosis

 

 

 

 

 

Neurological Manifestations of Alcoholism

1.Withdrawal

2.Wernicke/Korsakoff

3.Peripheral neuropathy

4.Cerebellar degeneration

5. Central pontine Myelinosis

6.Retrobulbar neuropathy

7 Psychosis

 

 

 

 

Hypervitaminosis A
"Increased Vitamin A makes you HARD":
Headache/ Hepatomegaly
Anorexia/ Alopecia
Really painful bones
Dry skin/ Drowsiness

 

 

AIDS Trials

CONCORDE    AZT not useful in early AIDS

                           Benefits show after CD4 counts begin to fall

ACTG                AZT reduces the risk of vertical transmission

DELTA               Combination therapy is better than monotherapy

 

 

AUDIT

systematic and critical evaluation ofquality of patient care

followed 1989 white paper

audit cycle    set standards

                       observe ones own standards

                       evaluate differences

                       change practice

                       set new standards