Delmar
Forum Senior
Topics: 22
Posts: 132
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ABDOMINAL AORTIC ANEURYSM (AAA):
About 20% will have a history of aortic aneurysm.
ABETALIPOPROTEINAEMIA
rare recessive disorder
inability to produce LDL
chylomicron formation is defective
characteristic features to age 2
-steatorrhoea, failure to thrive
-low serum lipids, acanthocytosis
later childhood
-ataxia, intention tremor, nystagmus
-athetosis, muscle weakness, dec. reflexes
-IQ normal but emotionally labile
-some develop retinitis pigmentosa
ABNORMAL P WAVES-criteria
right atrial abnormality (p pulmonale)
>2.6mm tall in an inferior lead
left atrial abnormality/hypertrophy
>0.12s wide with notch >=0.04s wide
ACANTHOSIS NIGRICANS-associations
(velvety brown thickness, pigmentation
wartiness and tendency to papilloma formation
in the axilla, groins +mucocutaneous
junctions e.g. angles of mouth)
GI malignancy esp. gastric
Ca lung
Diabetes Mellitus with insulin receptor
abnormalities.
ACANTHOSIS NIGRICANS:
CAUSES: gastrointestinal carcinoma (stomach, pancreas), lymphoma, acromegaly, diabetes mellitus and other endocrinopathies.
ACCOMODATION, FAILURE OF PUPIL CONSTRICTION
causes
-poor technique
-Parkinson's disease (+failed convergance)
-upper brain stem lesion
-diphtheria
ACEi INDUCED ANGIOEDEMA
Occurs in 0.1-0.2% of patients. 60% occur within the first week of therapy (range: hours -years). Most commonly involves the face. Class phenomenon. Mechanism unknown ? biochemical ?immunological.
REFERENCES:
1) Angioedema in relation to treatment with ACEi. BMJ.1992:304(6832):941-946.
2) Angioedema after substituting lisinopril for captopril. Ann. Int. Med. 1992;116(5):426-427.
3) Severe angioedema after long-term use of an ACEi. Ann.Int.Med.1990;112(4):312-313.
ACETYLATION-drugs affected
by slow acetylators
isoniazid-inc. neuropathy,dec. hepatitis,LE
hydralazine-LE
procainamide-LE
phenelzine
dapsone
acetlyated outside liver. no diff in slow acetylators
-some sulphonamides
-paraaminobenzoic acid
-paraaminosalicylic acid
ACHONDROPLASIA
autosomal dominant
one of the commonest forms of inherited dwarfism
physeal dysplasia - thin zone of cartilage cells, diminished columnar arrangement
short thick bones
spinal length almost always normal
features - short limbs, normal trunk, large head, saddle nose, exagerrated lumbar lordosis
normal mental and sexual development, spinal problems
homozygotes - neonatal death
(Harrisons)
ACNE ROSACEA (Har 13th 279,293)_
Erythema,telangectasia,pustules affecting the central face. Rare under 30yrs. F>M. May lead to rhinophyma formation.
Treatment: Oral tetracycline, topical metronidazole
ACOUSTIC NEUROMA:
- occuring at the cerebellopontine angle may present with hearing loss (VIII), facial weakness (VII), or an absent corneal reflex (V). The main differential is a meningioma.
ACROMEGALY
GH excess leads to bony+soft tissue overgrowth_Prevalence = 38/million. Incidence = 3/million/yr (M=F)_AETIOLOGY: 99% pituitary adenoma. 1% ectopic production of GHRH eg bronchial carcinoid tumours._SIGNS:
1) FACE: Coarsening of facial features (100%), enlarged tongue (macroglosia), enlarged lower jaw (prognathism), splaying of the teeth (70%), deep/husky/ resonant voice (laryngeal hypertrophy+ sinus enlargement), frontal bossing, hirsuitism, nasal polyps (15%)._2) EYES: Bitemporal hemianopia, Abnormal fundi ( optic atrophy, papilloedema, angioid streaks, diabetic or hypertensive changes)._3) THYROID: Goiter is common (IGF-I stimulation of thyroid cell growth). 3-7% of patients are hyperthyroid._4) AXILLA: Skin tags (60%), Acanthosis nigricans, oily skin._5) UPPER LIMBS: Proximal myopathy, thickened ulna nerve, carpal tunnel syndrome (50%). Spade like hands with doughy consistence, sweaty (95%). Arthralgia (90%)_6) CARDIAC: Signs of cardiomegaly (90%) and CHF. Hypertension (33%)_7) ABDOMEN: Organomegaly (liver, kidneys, spleen). Inguinal hernias (33%). Colonic polyps (correlate with skin tags). Incresed incidence of bowel cancer._8) TESTICLES: Hypogonadism. (33% impotent)._9) LOWER LIMBS: Proximal myopathy, arthritis (OA, pseudogout), foot drop (peroneal nerve entrapment), heel pad thickening.
10) OTHER ASSOCIATED DISORDERS: Obstructive sleep apnoea in 38% (hypersomnolence), Intracranial aneurysms (< 10%), Glucose intolerance (30-50%), Diabetes (10%). Hyperprolactinaemia (15%), Hypopituitarism (10%), Increased bone density, elevated serum phosphate (50%), hypercalciuria in 50% (predisposes to stones).
DIAGNOSIS:_1) X-RAY: Pituitary fossa enlarged in 90-95%. Heel pad thickness > 22mm in 95%._2) FASTING GH LEVELS: Usually elevated (20x normal) but may be normal in up to 10% of cases. GH is secreted in a pulsatile fashion with increased frequency._2) GH LEVEL FOLLOWING GLUCOSE: GH measured 60-120min after 100g glucose . In acromegaly there is failure to suppress GH to < 2ug/l which is the normal response (with acromegaly usually > 10ug/l)._3) SERUM SOMATOMEDIN-C (IGF-1) LEVELS: Increased, also increased in puberty and pregnancy._
TREATMENT: _1) TRANSSPHENOIDAL SURGERY: - The primary therapy curative in 60-70%.
2) RADIATION: - Given post-op if not cured, cures 50% but can take up to 5 yrs. (Defn. of cure = normal GTT)
3) SOMATOSTATIN (octreotide):- Used while awaiting cure from radiotherapy. 80% of cases have a reduction in GH levels , in 50% the reduction is in the cure range (<5ug/l). In 70% the IGF-1 levels return to normal, Tumour shrinkage occurs in 37%, clinical improvement occurs in 70%, Gallstones occur in 20%. _
ACROMEGALY-features
osteoporosis
inc. renal mass, thickened heel pad
inc. depth of frontal sinuses
90% have enlarged sella turcica
inc. body hair + hirsuitism in females
impotence in males, sweatiness
nerve entrapment, rarely sensory polyneuropathy (nerve thickening)
somatomedin levels raised in acromegalics
prolactin raised in 25%
can be caused by carcinoids
clinical response to somatostatin
paradoxically
-TRH causes an inc. in GH
-raised glc causes an inc. in GH
-dopaminergic drugs cause dec. in GH
MEN I
ACUTE CORTICAL NECROSIS-causes
abruptio placentae
eclampsia
septic abortion
acute pyelonephritis
any cause of prolonged + intense ischaemia
N.B. rare, 1-2% of all patients with apparent
acute tubular necrosis
ACUTE DISSEMINATING ENCEPHALOMYELITIS:
Monophasic illness which may follow infection (Measles, mumps, influenza, EBV) or vaccination (small pox, rabies). Severity and onset is variable. Motor and/or sensory findings may be present. Cerebellar signs common. Protein and lymphocytes may be raised in the CSF. Recovery may not be complete, particularly in those severely affected. Treatment is with IV methylprednisolone 1g daily for 3 days followed by a 3 week tapering course of prednisone.
ACUTE GONOCOCCAL INFECTION - Rx
amoxycillin 3g stat + probenecid 1g
or Trobicin 2g (M) 4g (F) IM stat
give doxycycline 100mg bd for 10 days
for simultaneous chlamydia infection
complex infection salpingitis/epidydimitis
amoxycillin 500mg tds 5-7 days
surveillance swabs at 2 and 7 days following Rx
(SHC, Hamilton)
ACUTE HEPATITIS-drug induced
(NB not sex hormones)
methyl dopa
isoniazid
halothane
ketoconazole
nitrofurantoin
phenothiazines-cholestatic hepatitis
dantrolene
subacute picture
-amiodarone
-perhexiline
-verapamil
ACUTE INTERMITTANT PORPHYRIA-drugs
main precipitants
-barbiturates
-sulphonamides
-griseofulvin
others
-phenytoin
-dichloralphenazone
-meprobamate
-glutethamide
-imipramine
-ergot preperations
safe
-sedatives other than barbiturates
-opiates
-penicillin, tetracycline, chloraphenicol
-streptomycin
-prochlorperazine
-digoxin
-corticosteroids
ACUTE INTERMITTENT PORPHYRIA-features
autosomal dominant expressed more in girls
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
ACUTE LEUKAEMIA-increased risk with
Down's, Kleinfelter's
ataxia telangiectasia
Fanconi's anaemia
Hodgkin's disease
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VENI VIDI VICI
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| smitha
Forum Elite
Topics: 53
Posts: 236
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Thanq delmar..... 
Good luck to u too.........hope u too r the anxious individual like me & many,waiting for ur step2 to get done...... 
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| werefrenz
Forum Newbie
Topics: 0
Posts: 4
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that was very informative. but shorter posts eg. one for each diagnosis would be better for viewer of the forum. (it will earn you more points too). anyway, good work, mate.
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| Delmar
Forum Senior
Topics: 22
Posts: 132
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as u said, informative and collective together. no need to scatter info just to gain some points LOL,
whats the use of those points in the 1st place? do they add to my score hehehheehe
we'r here primarly to share buddy not to earn points
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VENI VIDI VICI
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sorry but lowered and not elevated glucose
causes an increase of groth hormone
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