#hptss

[doctorfoxtor]

i wanna cry cry cry but i like to party

100 days of productivity

day 36 + 37

CVS/RS

PDAs beyond 3-4 days are actually unlikely to spontaneously close and require indomethacin

both hyper- AND hypokalaemia cause PR prolongation

CHF: consider biventricular pacemaker if pt w/ LBBB or QT prolongation or persistent NYHA 3/4 despite treatment

aortic root dilation z-score >2 (by extension, active AR) is a major criterion for Marfan's diagnosis

posteromedial papillary muscle ruptures more frequently than anterolateral as PM is only supplied by RCA vs AL is supplied by both LAD and LCx

pleural fluid eosinophils actually signifies air in the pleural cavity and unlikeliness of TB/malignancy

CNS/Ophthal/Psych

cerebellar stroke vs BPPV or vestibular neuritis: vertical nystagmus + dizziness >1 min + difficulty standing up w/o support even w/ eyes open in stroke

brachial plexitis/neuralgic amyotrophy: severe pain followed by patchy LMN-type weakness and wasting of a limb with (characteristically) winging of ipsilateral scapula and mild sensory disturbance after vaccination, childbirth, surgery/trauma or infection; CSF: mild ↑albumin/lymphocytes, EMG: axonal neuropathy; spontaneous recovery over months

HIVANDs: diffuse, hazy white matter signal change & NFNDs vs PMLE: localised, posterior brain changes w/ focal signs

oscillopsia (jerky nystagmus with alternating direction) localises to the flocculonodular lobe of the cerebellum

convergence-retraction nystagmus localises to the midbrain

Derm/Immuno

erythema gyratum repens = concentric erythematous annular plaques that evolve into polycyclic lesions with raised edges and a 'wood-grain' appearance (IRL, it has a serpiginous look, sort of like cutaneous larva migrans) (!internal malignancies)

erythema annulare centrifugum = expanding annular lesions with bumpy raised edges; extremely similar to tinea, differentiate by the trailing scale (WITHIN the edge in EAC, ON or WITHOUT the edge in tinea)

bullous pemphigoid: biopsy can show a neutrophilic infiltrate w/ eosinophilic predominance

DLE: sun-exposed well-demarcated eryth plaques, patchy alopecia that heals w/ scarring, PIH; tx w/ high-potency topical steroids, even if on the face (usually we do not use HPTSs on the face but this is a rare indication)

in GPA, frequency of organs involved is LRT+URT (90%) > kidneys (80%) > muscles > GIT > skin

hyposplenism in coeliac/IBD thought to be d/t enteric loss of lymphocytes and macrophages through inflamed mucosa leading to atrophy of reticuloendothelial system, and/or d/t intereference by circulating AgAb complexes

maternal anti-Ro more common than anti-La in congenital heart block

Onc/Haem

VTE in DCLD: although hepatic clotting factor synthesis is lost, hepatic synthesis of antithrombin/protein C/protein S is also lost, and hepatic clearance of factor 8 (which is synthesised purely in endothelium) is also lost

platelet transfusions → ↑risk of bacterial contamination vs other types of blood products

Renal/GIT

Liddle syndrome: epithelial Na-channel hyperactivation characterised by resistant HTN, ↓K, ↑pH, ↓renin, ↓aldosterone; exquisitely sensitive to triamterene/amiloride

medullary sponge kidney: dilation of collecting ducts in papillae, cystic changes w/ small calculi inside, hypercalciuria, ±RTA, ±hemihypertrophy

acute severe ulcerative colitis → Truelove and Witts criteria: core temp >38, bloody stools >6x/day, ESR >30, PR >90

Pharm/Toxo

amitriptyline has anti-dopaminergic effects → hyperprolactinaemia

lead neuropathy is motor (nerve palsies), very rarely sensory, and not commonly assoc w/ tremors

lead also only causes anterior uveitis, not mid-/pan-/posterior uveitis; and proximal tubule or interstitial kidney disease, not glomerular disease

[joeljoelwarr]

"Mr. and Mrs. Dursley, of number four Privet Drive, were proud to say they were perfectly normal, thank you very much."

Harry Potter and The Philosopher's Stone