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Goodpasture’s syndrome (anti-GBM antibody disease)

  This is a rare, genetic, autoimmune condition characterised by a combination of glomerulonephritis with alveolar hemorrhage in the presence of circulating anti-glomerular basement membrane (GBM) antibodies.  Circulating anti-GBM antibodies bind to basement membranes in the kidneys and lungs, fix complement and trigger a cell-mediated inflammatory response, causing glomerulonephritis and pulmonary capillaritis.    Specific predisposing factors include the following: Association with HLA-DR2  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Extradural Haemorrhage

Extradural Haemorrhage aka Epidural Haemorrhage Blood collects between the dura mater and the bone of the skull. The dura is stripped away from the skull – indicating a high pressure bleed. On CT and MRI, it has a classical lentiform (lens) shaped appearance.   Pathology  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Comparison of Intracranial Haemorrhage

Comparison of Intracranial Haemorrhage Feature  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Antepartum Haemorrhage (APH)

 
almostadoctor.com - free medical student revision notes
over 6 years ago
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Hormonal Implants

Implant – aka Implanon Lasts 3 years 12% will have heavier bleeding, particularly in the first 6-12 months. This can be alleviated with: Tranexamic acid – 1g/6-8h for up to 4 days – an antifibrinolytic, can reduce menorrhagia by 50%  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Post Coital Bleeding

Causes InfectionChlamydia, gonorrhoea, trichomoniasis (rarer cause) Risk factors – ask about partners (number of partners, protection, Hx of sexually transmitted infection etc) Ask about other symptoms –discharge, pain Cervical / endometrial polyps  
almostadoctor.com - free medical student revision notes
over 6 years ago
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von Willebrand's Disease

Most common inherited bleeding disorder (asymptomatic deficiencies 1%, symptomatic disease 100 per million) von Willeband factor (vWF) important in platelet adhesion and factor VIII transport Types of vWDType 1: decreased concentration of vWF, 80%, often autosomal dominantType 2: qualitative deficiency – AD or AR inheritance  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Henoch Schonlein Purpura (HSP)

This is a vasculitis that most commonly occurs in children. It tends to only affect the small vessels, and typically presents with: Palpable purpura – red/purple discolorations in the skin, often on the extensor surfaces of the feet, legs, arms, or sometimes on the buttocks. The rash may initially resemble urtricaria, but later becomes palpable. GI disturbance – may include colicky abdominal pain, abdominal tenderness, melena – occurs in 50% of patients  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Myelofibrosis

Marrow fibrosis and splenomegaly, de novo or following transformation of PV or ET Usually >50 years old Abnormal megkaryocytes produced in increased numbers. PDGF and TGFβ are released by megakaryocytes, stimulating fibrosis. Haematopoietic stem cells move to the spleen and liver Presentation: fatigue, weight loss, splenomegaly, splenic pain, portal hypertension, bleeding varices, ascites and hepatomegaly  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Haemophilia A

X-linked recessive condition, deficiency of factor VIII, prevalence 1 in 10,000 Range of possible mutations, 30% of cases due to sporadic mutation Low factor VIII levels predispose to bleeding – risk proportional to factor VIII level Mild disease (11-30 units/dl) risk after significant trauma/surgery Moderate disease (2-10 units) - minor trauma  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Anaemia of Chronic Disease

This is common, particularly in the hospital setting. It occurs as a result of: Chronic infection Chronic inflammation Neoplasia The anaemia is not related to bone marrow, bleeding or haemolysis, and is generally mild (Hb of 8.5-11.5g/dl).  
almostadoctor.com - free medical student revision notes
over 6 years ago
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Too much bleeding

Medical Protection Society Website  
medicalprotection.org
over 6 years ago
Foo20151013 2023 1u6up6r?1444774235
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Keep on Truckin’

Shattered. Third consecutive day of on-calls at the birth centre. I’m afraid I have little to show for it. The logbook hangs limply at my side, the pages where my name is printed await signatures; surrogate markers of new found skills. Half asleep I slump against the wall and cast my mind back to the peripheral attachment from which I have not long returned. The old-school consultant’s mutterings are still fresh: “Medical education was different back then you see....you are dealt a tough hand nowadays.” I quite agree, it is Saturday. Might it be said the clinical apprenticeship we know today is a shadow of its former self? Medical school was more a way of life, students lived in the hospital, they even had their laundry done for them. Incredulous, I could scarcely restrain a chuckle at the consultant’s stories of delivering babies while merely a student and how the dishing out of “character building” grillings by their seniors was de rigeur. Seldom am I plied with any such questions. Teaching is a rare commodity at times. Hours on a busy ward can bear little return. Frequently do I hear students barely a rotation into their clinical years, bemoan a woeful lack of attention. All recollection of the starry-eyed second year, romanced by anything remotely clinical, has evaporated like the morning dew. “Make way, make way!...” cries a thin voice from the far reaches of the centre. A squeal of bed wheels. The newly crowned obs & gynae reg drives past the midwife station executing an impressive Tokyo drift into the corridor where I stand. Through the theatre doors opposite me he vanishes. I follow. Major postpartum haemorrhage. A bevy of scrubs flit across the room in a live performance of the RCOG guidelines for obstetric haemorrhage. They resuscitate the women on the table, her clammy body flat across the carmine blotched sheets. ABC, intravenous access and a rapid two litres of Hartmann’s later, the bleeding can not be arrested by rubbing up contraction. Pharmacological measures: syntocinon and ergometrine preparations do not staunch the flow. Blood pressure still falling, I watch the consciousness slowly ebb from the woman’s eyes. Then in a tone of voice, seemingly beyond his years, the reversely gowned anaesthetist clocks my badge and says, “Fetch me the carboprost.” I could feel an exercise in futility sprout as I gave an empty but ingratiating nod. “It’s hemabate....in the fridge” he continues. In the anaesthetic room I find the fridge and rummage blindly through. Thirty seconds later having discovered nothing but my general inadequacy, I crawl back into theatre. I was as good as useless though to my surprise the anaesthetist disappeared and returned with a vial. Handing me both it and a prepped syringe, he instructs me to inject intramuscularly into the woman’s thigh. The most common cause of postpartum haemorrhage is uterine atony. Prostaglandin analogues like carboprost promote coordinated contractions of the body of the pregnant uterus. Constriction of the vessels by myometrial fibres within the uterine walls achieves postpartum haemostasis. This textbook definition does not quite echo my thoughts as I gingerly approach the operating table. Alarmingly I am unaware that aside from the usual side effects of the drug in my syringe; the nausea and vomiting, should the needle stray into a nearby vessel and its contents escape into the circulation, cardiovascular collapse might be the unfortunate result. Suddenly the anaesthetist’s dour expression as I inject now assumes some meaning. What a relief to see the woman’s vitals begin to stabilise. As we wheel her into the recovery bay, the anaesthetist unleashes an onslaught of questions. Keen to redeem some lost pride, I can to varying degrees, resurrect long buried preclinical knowledge: basic pharmacology, transfusion-related complications, the importance of fresh frozen plasma. Although, the final threat of drawing the clotting cascade from memory is a challenge too far. Before long I am already being demonstrated the techniques of regional analgesia, why you should always aspirate before injecting lidocaine and thrust headlong into managing the most common adverse effects of epidurals. To have thought I had been ready to retire home early on this Saturday morning had serendipity not played its part. A little persistence would have been just as effective. It’s the quality so easily overlooked in these apparently austere times of medical education. And not a single logbook signature gained. Oh the shame! This blog post is a reproduction of an article published in the Medical Student Newspaper, February 2014 issue.  
James Wong
over 6 years ago
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Post Partum Haemorrhage - A Summary of Management

A powerpoint presentation made for 4th year medical students summarising the management of PPH  
Adam Collins
over 6 years ago
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What are the influencing factors of blood pressure?

My Professor asked on the first day of my semester "What are the influencing factors of blood pressure?" I only know a few and there are more. Correct me if I am wrong but I believe: Stress Smoking Alcohol Obesity Haemorrhage Heart disease High body temperature Can someone help me please?  
Keysha Mendoza
over 7 years ago
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My Grandfather's Complimentary Medicine - The secret to a healthy old age?

Complimentary medicine (CAM) is controversial, especially when it is offered by the NHS! You only have to read the recent health section of the Telegraph to see Max Pemberton and James LeFanu exchanging strong opinions. Most of the ‘therapies’ available on the market have little to no evidence base to support their use and yet, I believe that it has an important role to play in modern medicine. I believe that CAM is useful not because of any voodoo magic water or because the soul of a tiger lives on in the dust of one of its claws but because modern medicine hasn’t tested EVERYTHING yet and because EVERY DOCTOR should be allowed to use a sugar pill or magic water to ease the anguish of the worried well every now and again. The placebo effect is powerful and could be used to help a lot of patients as well as save the NHS a lot of money. I visited my grandfather for a cup of coffee today. As old people tend to do we discussed his life, his life lessons and his health . My grandfather is 80-something years old and worked as a collier underground for about 25 years before rising up through the ranks of management. In his entire life he has been to hospital twice: Once to have his tonsils removed and once to have a TKR – total knee replacement. My granddad maintains that the secret of his good health is good food, plenty of exercise, keeping his mind active and 1 dried Ivy berry every month! He takes the dried ivy berries because a gypsie once told his father that doing so would prevent infection of open wounds; common injuries in those working under ground. It is my granddad’s firm belief that the ivy berries have kept him healthy over the past 60 years, despite significant drinking and a 40 year pack history! My grandfather is the only person I know who takes this quite bizarre and potentially dangerous CAM, but he has done so for over half a century now and has suffered no adverse effects (that we can tell anyway)! This has led me to think about the origin of medicine and the evolution of modern medicine from ancient treatments: Long ago medicine meant ‘take this berry and see what happens’. Today, medicine means ‘take this drug (or several drugs) and see what happens, except we’ll write it down if it all goes wrong’. Just as evidence for modern therapies have been established, is there any known evidence for the ivy berry and what else is it used for? My grandfather gave me a second piece of practical advice this afternoon, in relation to the treatment of open wounds: To stop bleeding cover the wound in a bundle of spiders web. You can collect webs by wrapping them up with a stick, then slide the bundle of webs off the stick onto the wound and hold it in place. If the wound is quite deep then cover the wound in ground white pepper. I have no idea whether these two tips actually work but they reminded me of ‘QuickClot’ (http://www.z-medica.com/healthcare/About-Us/QuikClot-Product-History.aspx) a powder that the British Army currently issues to all its frontline troops for the treatment of wounds. The powder is poured into the wound and it forms a synthetic clot reducing blood loss. This technology has been a life-saver in Afghanistan but is relatively expensive. Supposing that crushed white pepper has similar properties, wouldn’t that be cheaper? While I appreciate that the two are unlikely to have the same level of efficacy, I am merely suggesting that we do not necessarily dismiss old layman’s practices without a little investigation. I intend to go and do a few searches on pubmed and google but just thought I’d put this in the public domain and see if anyone has any corroborating stories. If your grandparents have any rather strange but potentially useful health tips I’d be interested in hearing them. You never know they may just be the treatments of the future!  
jacob matthews
over 7 years ago
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Stroke: Lobar haemorrhage - radiology video tutorial (MRI, CT)

"Stroke Series" video 2 of 7: Lobar haemorrhage and hypertensive haemorrhage are two distinct forms of haemorrhagic stroke. This video discusses the imaging characteristics of primary lobar haemorrhage, the underlying pathology (cerebral amyloid angiopathy) and the relevant differential diagnosis.  
Radiopaedia
over 7 years ago
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Stroke: Hypertensive haemorrhage - radiology video tutorial (MRI, CT)

"Stroke Series" video 1 of 7: Hypertensive haemorrhage and lobar haemorrhage are two distinct forms of haemorrhagic stroke. This video discusses the imaging characteristics of hypertensive haemorrhage, the underlying pathology (Charcot-Bouchard aneurysms) and the relevant differential diagnosis.  
Radiopaedia
over 7 years ago
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Why are Sengstaken–Blakemore tubes rarely used?

I have read that Sengstaken–Blakemore tubes are used for a bleeding oesophageal varices. However, I was talking to a doctor in hospital the other day and they said that they are not often used in actual practice. Is this true and if so why?  
Steve Wilson
over 7 years ago
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What causes enlarged platelets?

Hey everyone, A day before i was having a look at a cbc report which reported enlarged platelets. the patient has not gone through any sort of injury or bleeding disorders. what might be the other reasons of enlarged platelets either pathological or physiological ?  
komal zafar
almost 8 years ago