Part 2 Set B

If they have had an arterial event, thrombophilias are unlikely as they tend to cause venous thrombosis.

High false positive rate, especially with antiphospholipid assays. 

No consensus on optimal treatment.

• 3-4mmols = IV Saline with or without furosemide to induce diuresis and strict IO chart.
• Monitor serum sodium+osmolality as they will rise.

>4mmols = Dialysis

• Prothrombin > 100s
• PH<7.3 regardless of encephalopathy (15% survival)
• Creatinine > 300 with grade 3 or 4  encephalopathy (30% survival)

These are all indications for liver transplant

Amitriptyline 25mg as soon as the rash appears,

can increase up to 75mg

EBV infection

• IgA nephropathy
• Renal biopsy - IgAimmunofluorescence and C3 would be visualised

Treat with ACE inhibs and Steroids

• Clarithromycin
• Ciprofloxacin
• Rifampicin

• Single dose Ciprofloxacin
• Rifampicin BD for 2 days (Not for girls on the pill as enzyme inducer)
• Single dose IM Ceftriaxone

Proprionibacterium Acnes

Prolonged IV Abx at time of revision are effective.

Symptomatic, even at strenuous levels of exercise

Valve gradient of 50-60mmHg

• Antibiotics - Co-amox, fluclox
• Statins
• Anti-epileptics
• Anti-TB - Isoniazid, Rifampicin
• Cardiac drugs - Verapamil, enalapril, Atenolol
• Halothanes
• Cytotoxics
• Clonazepam

• Age>40
• Female
• Endemic Goitre
• Hashimotos - Thyroid Lymphoma
• Radioiodineradiotherapy
• Previous Thyroid adenoma
• FAP

MRA brain

Anticoagulation to prevent thromboembolic sequelae.

Pathergy sign - associated with Behcets

• Wegner's
• Microscopic polyarteritis
• Essential mixed cryoglobulinaemia

A drop in BP on Inspiration. Must be greater than 10mmHg

• Anything that presses on the heart:
• Pericardial effusion
• Constrictive pericarditis 
• COPD

• Adherent white plaques on the edge of the tongue
• Caused by reactivation of EBV in the presence of immuosuppresion
• No specific treatment, just need to treat the underlying cause. Usually HIV

Haemolysis that occurs at body temperature

EXTRAVASCULAR because it is usually IgG mediated and so is poor at activating complement but bettter at being mopped up by phagoctyes and kuppfer cells in the spleen and liver.

Idiopathic (50%), Lymphoproliferative disorders, Autoimmune disorders, Infection, Other neoplasms

Small intracellular pathogen - Brucella melitensis

• Endemic to cattle in central america
• Acuquired by drinking unpasturized milk and eating undercooked meat
• Bone pain, neuropsych symptoms, Hepatosplenomegaly and bone marrow supression
• Causes chronic disease if untreated
• Test of choice is bone marrow aspirate + culture as blood cultures can take 4-6 weeks
• 6 weeks of doxycycline with strep or rifampicin. Quinilones can also be used.

• Caused by Burkholderia pseudomaleii - gram negative organism found in soil and water
• Mainly in Thailand, the banana pancake trail and Australia

Presents acutely as atypical pneumonia or with bonejoint pain

Chronic form is very similar to TB and has been called 'Vietnamese TB'

Treat with high intensity IV phase and then an oral eradication phase.

Carotid artery dissection that's taken out the hypoglossal and the facial.

• A fungal disease
• Caused by Histoplasma capsulatum
• Slowly progressing form occurs in immunocompetent
• Acute disseminated form occurrs in the others
• Adrenals are commonly affected in disseminated form
• Grocott's silver stain will get you the diagnosis from an FNA or biopsy.
• Treat with Itraconazole

Decreases cortisol synthesis by inducing several P450enzymes.

Used to control BP and Serum glucose pre-surgically in the lead up to trans-sphenoidal surgery.

Roughly about 10 times as many patients need to be studied in a trial versus the number needed to see 1 event.

• Anaemia
• Lytic bone lesion
• Hypercalcaemia
• Renal failure
• Bence Jones protein

Pharyngitis and flu-like illness.

Happens when a CMV negative recipient gets a kidney from a CMV positive donor.

Its a worry because it accelerates transplant failure.

Treat with IV Gancyclovir.

• >30% = Headaches and dizziness
• 40-60% = Syncope, tachycardia, tachypnoea, seizures
• >60% = Cardioresp failure and death

100% O2 via non-rebreathe and consider hyperbaric therapy.

Useful markers for neuroendocrine differentiation of neoplasms

• Diabetes
• Cholelithiasis
• Diarrhoea
• Steatorrhoea
• Hypochlorhydria
• Anaemia
• Wt Loss

Large volume secretory diarrhoea

• Watery diarrhoea
• Chronic Duodenal ulcers
• Multiple endocrine tumors

• Mild glucose intolerance
• Necrolytic Migratory Erythema
• Anaemia
• Psychiatric disturbance
• Thromboembolic disease

A ring of small smooth papules on the hand and feet. Looks very much like urticaria but not itchy.

Assoc with Diabetes. Most common in women below the age of 30.

• Renal impairment
• Liver impairment
• Basically anything that would make Lactic acidosis worse.

Hydrops Fetalis (accumulation of fluidoedema in 2 or more foetal compartments)

• Surgical debulking
• Oral Alkylating agents
• Bevacizumab in clinical trials

Median survival = 1 year

Dual chamber pacemaker

• Pulm odema
• CV collapse
• Apnoea
• Paralysis

Intubate, ventilate, 

• Dicobalt edetate first line 
• sodium nitrite and sodium thiosulphate are alternatives.

• Horizontal nystagmus
•  It is protein bound therefore haemodialysis and and plasmapheresis are of no use.

• Urinary porphyrins are raised in all three acute porhyrias; AIP, hereditary coporphyria and Varigate porhyria
• Faecal porhyrins raised in Varigate and HCP only
• Serum porphyrins raised in Varigate only

Photo-sensitive skin lesions are present in Varigate and Porhyris cutanea tarda

Methanol will bur disc margins and keep your calcium normal

• Mitral stenosis with ASD - more common in women because more women have ASDs
•  
• Causes mixed signs on CV exam (diastolic murmur, loud S1, left heave and tapping apex)

• Causes fatigue, SOB and AF in middle age.
• Needs op to prevent Eissenmengers

HIT1 - Occurs within 48-72hrs, Need to stop offending agent. Platelets dont drop below 100

HIT 2 - Occurs later than that platelets drop below 100, need to stop offending agent

In both cases chat to Haem about what agent next - lepirudin etc

• Sensorimotor polyneuropathy
• Gastrointestinal symptoms
• Weightloss
• Hyperkeratosis of the palms
• Transverse lines on nail beds - Mees lines

Treat with penicillamine

Found in rodent pesticides, rice, drinking water, smelting occupations.

Organisms in pus dont tend to grow in micro labs

pH <7.2 is what you're looking for

t(8:14) = Burkitts, c-myc with an Ig heavy locus

t(15:17) = Acute promyelocytic leukaemia, PML-RAR

t(9:22) = ALL and CML - BCR-Abl

t(11:22) = Mantle cell lymphoma - cyclinD1 to Ig heavy locus

• Females
• Yoga
• Ceiling painting
• Judo
• nose blowing
• Spinal manipulation
• minor trauma

LMS = Ipsilateral facial dyaesthesia, dysarthria, hoarseness. Ipsilateral limb numbness + CONTRALATERAL loss of pain + temp. Vertigo, dysequilibrium, diplopia, dysphagia.

MMS = Contralateral weaknessparalysis (pyramidal tract damage before the decussation). Contralateral Numbess. Ipsilateral horners.

• My - Myoglobin
• Cat - CK
• Takes - Troponin
• LSD - LDH

• Isolated rise in ALT.
• Found incidentally