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Medical Topics

Iron studies

A chart to aid in the interpretation of iron studies. These are set of blood tests which may include ferritin, serum iron, transferrin, transferrin saturation and TIBC.

Serum iron –Means ferric ions Fe3+ bound to serum transferrin Only 0.1 % of total body iron is bound to transferrin at any one time Little value if tested on its own as levels may fluctuate through the day.

The limping child

The limping child- a summary of main causes and assessment in general practice.

Causes can be divided based on age, anatomy or pathology.

Infants < 1 year –Trauma including NAI Septic arthritis / osteomyelitis Developmental dysplasia of hip.Young children 1-4 yrs –Transient synovitis Trauma including NAI and toddler’s fracture Septic arthritis / osteomyelitis Developmental dysplasia of hips (DDH ) Perthe’s disease.School aged children-Trauma Transient synovitis Septic arthritis / osteomyelitis Perthe’s disease Psychogenic pain -less common.

Non-blanching rash in a child

A quick visual on the common causes of a non-blanching rash ( NBR ) in childhood. NBR is any rash in which the colour does not change with direct pressure.

A NBR can be petechiae or purpura or both. It happens due to extravasation of blood from the vasculature into the skin or mucus membranes.

Constipation in children- Management

A brief overview of the current management of functional constipation in children.

FAECAL 
IMPACTION TREAT WITH MACROGOL 1ST LINE AND THEN C/O MAINTENANCE THERAPY

Faecal impaction is defined as a hard mass in the lower abdomen identified on physical examination or a dilated rectum filled with a large amount of stool on rectal examination or excessive stool in the distal colon on abdominal radiography NICE recommends to use a combination of history and physical examination to diagnose to diagnose faecal impaction -take note of overflow soiling and / or faecal mass palpable abdominally and / or rectally if indicated 30-75 % of constipated children suffer with impaction More than 90 % of children with faecal incontinence also suffer with impaction Treatment of impaction may initially increase the symptoms of soiling and abdominal pain –

Red eye

Subconjunctival haemorrhage – Heme under the subconjunctiva due to bleeding into the subconjunctival space usually asymptomatic risk and contributing factors may include
○ trauma
○ rubbing
○ cough or straining
○ hypertension
○ antiplatelets and anticoagulation
○ bleeding disorders -if recurrent unilateral

.The sclera can be completely covered in blood in severe cases Normal VA PERLA well demarcated bright red patch on the white of sclera No corneal involvement IOP normal No pain but may cause slight irritation.

Breast pain

Breast pain ( mastodynia , mastalgia ) is a common symptom – occurs in 70 to 80 % of women some time in their lives 2nd commonest reason ( 1st is a lump ) for which a woman seeks help -for breast related issues ( even in older age group ) Breast pain is rarely associated with breast cancer
○ number quoted varies from 1 % to 0.5 % ( Normal breast examination and with only breast pain )
○ causes significant anxiety and fear in women who relate to and are convinced they have breast cancer Severe pain can affect QOL- particularly
○ sleep patterns
○ sexual activity
○ physical activity
○ work ,

Prostate cancer

Malignant neoplasm of the prostate gland
 ( PCa is a widely used acronym to denote prostate cancer )

How common- Second most prevalent cancer in men worldwide ( Lung cancer is first ) Happens more in developed countries – incidence of PCa is less in Asian countries compared to Western nations In 2014 there were 46000 new diagnosis of PCa –

Methotrexate- Monitoring

A guide to monitoring methotrexate prescribing in primary care.

Folic acid antagonist – antimetabolite cytotoxic agent Inhibits dihydrofolate reductase – prevents DNA and RNA synthesis Anti-inflammatory effect Immunosuppressive action Tablets of 2.5 mg strength – once weekly Metoject® 7.5 mg , 10 mg , 12.5 mg , 15 mg , 17.5 mg ,

Carpal tunnel syndrome

Carpal Tunnel Syndrome or CTS is a common presentation in Primary Care. This review of CTS on A4Medicine presents the clinician with pathophysiology with relevant anatomy displayed for easy reference. CTS is the commonest compression neuropathy of the upper limb. Presentation of carpal tunnel syndrome and examination is discussed – specific tests as the Phalen’s, 

Clozapine in brief

Clozapine is an atypical antipsychotic –treatment of schizophrenia in
○ other agents cannot be tolerated- for e.g untreatable adverse reactions 
○ treatment resistant patients
 psychosis in Parkinson’s disease- where standard treatment has failed

Mechanism of action –Works as antagonist across several receptors
 serotonin dopamine cholinergic muscarinic adrenergic histamine H1 weak D2 blocking activity

Common side effects include
 constipation weight gain hypersalivation malaise speech disorders urinary incontinence drowsiness/ sedation dizziness tachycardia

Agranulocytosis ,

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