Acute / General Flashcards
Patient with EColi 0157.
Slightly raised WCC, PT, AKI, slightly low Plt (123)
Management
Majority recover spontaneously w best supportive care
Diarrhoea positive: supportive care
Diarrhoea negative: urgent plasma exchange
Eculizumab may have role in mx of atypical HUS
How does multifocal motor neuropathy present
MMN is autoimmune, progressive weakness in limb.
Normal sensation
Fasciculation
I’m the stomach, maltomas (aka marginal zone lymphomas) are associated with….
H pylori
I’m the eyes, maltomas (aka marginal zone lymphomas) are associated with….
Sjogren syndrome
I’m the thyroid, maltomas (aka marginal zone lymphomas) are associated with….
Hashimotos thyroiditis
I’m the bowel, maltomas (aka marginal zone lymphomas) are associated with….
Crohn’s or coeliac disease
Most common cause of ARDS
Sepsis… Causes increased permeability of pulmonary micro circulation, due inflammation causing leakage of fluid to lungs
Causes of acquired factor VIII deficiency
Assx with Psoriasis, Pemphigus, Pencillins, cePhalosporins and malignancy
Increased APTT
40yr old hpertensive patients despite max amlodipine and ramipril. What test?
? Primary hyperaldosteronism
So plasma Renin, aldosterone and cortisol levels after two weeks without antihypertensive. ACEi can increase renin, CA antag can reduce aldosterone
Features of niacin deficiency
Aka pellagra… Rare but can be seen in alcohol dependence/eating disorders
Dementia, dermatitis and diarrhoea……. But constipation not uncommon
Dermatitis is predominantly sun exposed areas
What gender and age are most likely to get malignant melanoma
Men over 50
Patient with absence of smell, and hypogonadotrophic hypogonadism diagnosis
Kallmans
Absent olfactory bulb in 75%
Management for idiopathic intracranial hypertension
Mainstay is weight loss, although not great evidence
Acetazolamide
topiramate(esp if migraine too)
Corticosteroids generally not recommended because of steroid withdrawal headaches
Serial LPs
1/3 relapse
Half have long-term visual problems
10% signif visual problems
Prognosis of idiopathic intracranial hypertension
Good response to meds but:
1/3 relapse
Half have long-term visual problems
10% signif visual problems
Features of brucellosis
Chronic granulomatous disease
Weight loss, splenomegaly, bone pain(in 55%)
PUO
Neutropenia & thrombocytopenia
Bone marrow aspiration and culture
Young patient with testicular tumour develops anxiety, tenor, diarrhoea. Why?
Raised bHCG, serum AFP and LDH can all be raised in germ cell tumors
bHCG is similar to TSH so can cause hyperthyroid state
GHB overdose management
Supportive…
Charcoal for up to 1h after ingestion
Presents with GI side effects Euphoria Drowsiness Cheyne's Stoke and coma Metabolic acidosis, hypergly, hyperkal ,hypernat
GHB overdose features
Presents with GI side effects Euphoria Drowsiness Cheyne's Stoke and coma Metabolic acidosis, hypergly, hyperkal ,hypernat
Dissolves in water and tastes like seaweed!
Gi High Breathing
Rib notching on CXR…. Other signs?
Coarctation of the aorta
With late systolic murmur and radiofemoral delay
Women asking chance her child has CF
Husband carrier
Prevalence 1/20
1/20 (female carrier risk) X 1/2 (male risk) X 1/2 (female risk of passing gene on
So 1/80
Dislocation of lens upwards Vs downwards
Downwards in homocysteinuria
Upwards in Marfan’s
What’s the r mutation in peutz jeghers syndrome
STK 11
Serine / threonine kinase
Positive serology for syphilis but presentation with multiple ulcerating subcut nodules present for many years
Diagnosis
Yaws
Caused by Treponema pertenue - indistinguishable serology to syphilis…can be present for many years too
Also treated with penicillin though
Skin-skin transmission
multiple lesions appear all over the body
Features of legionella
Dry cough, D+V, elevated transaminase, relative Bradycardia
Pleural effusion in 50%
Hyponat
lymphopenia
Features of hashimotos encephalopathy
Behavioural, psychiatric disturbance with sensory phenomena
Also assx with anti TPO antibodies
Which lqt has congenital deafness
Jowel and Lange-Nielson syndrome has profound deafness
RomaNO ward = NO deafness
Mean age of primary pulmonary hypertension
36 years old
Exertional dyspnoea, syncope and RHF
Going under GA, becomes rigid, temp 42, high pCO2
Malignant hyperthermia due to isoflurane or halothane
Patient with clubbing and long bone pain
Bone scan showing symmetrical uptake in trabecular bones and the periarticular surfaces
Hypertrophic pulmonary osteoarthropathy…….. Seen in bronchial carcinoma
Immunology screen of patient with alcohol excess
Raised IgA
Malignancy + raised CK + symmetrical proximal weakness
?polymyositis
Treat with prednisolone
Granulomatosis with polyangiitis (Wegener’s granulomatosis) Vs churg Straus
graNulomatosis wegeNers Nose - saddle-shape nose deformity, epistaxis, sinusitis, nasal crusting
Both can have sinusitis
Acute heart failure not responding to medical treatment with severe dyspnoea
Consider CPAP
Triad for Wernicke’s encephalopathy
Ophthalmoplegia, ataxia, encephalopathy
nystagmus is the most common ocular sign
Gram-positive bacilli (or rods)
ABCDL Actinomyces Bacillus anthracis Clostridium, Corynebacterium Diphtheria Listeria monocytogenes
criteria for decompressive hemicraniectomy in an acute stroke after presenting as a malignant MCA syndrome:
- 60 or younger
- Clinical deficits suggestive of infarction in the territory of the middle cerebral artery, with a score on the National Institutes of Health Stroke Scale (NIHSS) of above 15.
- Decrease in the level of consciousness to give a score of 1 or more on item 1a of the NIHSS.
- CT showing infarct > 50% of the MCA territory, with or without additional infarction in the territory of the A or PCA on the same side, or infarct volume greater than 145 cm3 as shown on diffusion-weighted MRI.
Patient with HIV and asthma develops cushingoid features…why
HIV protease inhibitors are p450 inhibitors, so cause steroid build up from inhalers
Like atazanavir and ritonavir
Thrombectomy after stroke
together with intravenous thrombolysis (if within 4.5 hours)…
Within 6hr if confirmed occlusion of the proximal anterior circulation
Or from 6-24hr confirmed occlusion of the proximal anterior circulation with salvageable tissue
Management in an arrest if patient is in asystole , given Adrenaline and develops p-waves
P-wave systole….
external pacing can result in a return of spontaneous circulation
Management of immunocompromised patients with neuro toxo - multiple ring enhancing lesions on CT
pyrimethamine and sulphadiazine.
dactylitis and distal interphalangeal swelling, joint pain
Psoriatic arthritis even if no skin changes
Triad of thallium poisoning
fluctuating mood, with or without confusion, painful distal paraesthesia and alopecia
- sudden painless loss of vision,
severe retinal haemorrhages on fundoscopy
Central retinal vein occlusion
What is carcinoid syndrome
When metastases are present in liver and release serotonin
Investigation: urinary 5-HIAA
Investigation for GBS
Raised CSF protein and normal WBC
Can do nerve conduction
Definition of TIA
transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischaemia, without acute infarction.
50yr presents with seizure and drowsiness.
CT shows solid tumour with central necrosis and a rim that enhances with contrast
Glioblastoma
- most common primary tumour in adults
- poor prognosis (~ 1yr).
Intravenous urogram - clubbed calyces and ring signs.
Papillary necrosis
Caused by chronic analgesia use, sickle, TB, pyelonephritis,DM
Treatment for acute intermittent porphyria flare
Haem arginate and 10% dextrose can be used to treat flares of acute intermittent porphyria
(Will have increased levels of delta aminolevulinic acid and porphobilinogen in urine)
Causes of gram negative endocarditis
HACEK
Haemophilusspecies, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, (human bite) Kingellaspecies
absolute contraindication for electroconvulsive therapy
The only absolute contraindication for electroconvulsive therapy is raised intracranial pressure
What is beriberi
Vitamin B1 (Thiamin) deficiency,
dry beriberi: peripheral neuropathy
wet beriberi: dilated cardiomyopathy
Patient with gout. Previous asthma and also diarrhoea from colchicine. Management
For gout, if NSAIDs and colchicine are contraindicated or not tolerated (e.g. chronic kidney disease, asthma etc), the next option is a oral prednisolone
dyspnoea and hypoxaemia within 72 hours postoperatively
basal atelectasis -
mucous trapped in the bronchial tree results in small airway obstruction… Chest physio
Facioscapulohumeral muscular dystrophy inheritance
(FSHMD) is an auto dom muscular dystrophy.
Clue is in the name - affects the face, scapula and upper arms first, typically by years
Patient presents with foot drop, left ankle dorsiflexion (2/5) and eversion (2/5), intact ankle inversion and flexion of the big toe
More likely common peroneal palsy than L5 ridiculopathy because of intact ankle inversion / flexion of big toe
Common peroneal sensory loss is usually lat aspect of the lower leg and the dorsum of the foot
L5 sensory loss- thin strip down the middle of the anterior lower limb ( not lateral lower leg)
Young female patient presents with signs of stroke. CT brain angio shows “STRING OF BEADS” appearance. Diagnosis?
Fibromuscular dysplasia (FMD)
- a non-atherosclerotic, non-inflammatory condition producing segmental stenoses in all vascular beds
- confirm with CT angio of kidneys
Pleuritic pain in a pregnant lady, investigations in order
ECG & CXR -> bilateral leg dopplers (treat with LMWH if +ve)> if still uncertain , CTPA or VQscan (lower radiation)
RCOG says don’t do D Dimer
V/Q: increased risk of childhood cancer (1/50,000 v 1/1,000,000 in CTPA)
CTPA increased risk of maternal breast cancer (13.6%)
Patient is given digoxin for AF with fast VR but then deteriorates to fast broad complex tachy and becomes unresponsive. Cause?
Could be Wolf Parkinson White.. OR cardiac AL amyloidosis
Giving digoxin caused VF arrest
Patient presents with headaches. Normal CT and LP, MRI showed meningeal enhancement, thickening,, and shallow subdural hematoma
MRI scan are features of low pressure headaches, so oral fluids, caffeine/blood patch
Patient with RA develops mouth ulcers. Management
Stop methotrexate and speak to rheum
Management for optic neuritis
IV Methylprednisolone
Better visual recovery and reduced conversion to MS than oral pred
10y risk of MS 38% after initial episode of ON
56% if the MRI had one or more lesions
15y risk 50%
Investigation for idiopathic intracranial hypertension
LP for pressures >25
Visual field charting
CT venography to role out cerebral venous thrombosis
smudge cells
Larger percentage of smudge (aka smear) cells is better prognosticaly for CLL
Diagnostic test to confirm polyarteritis nodosa (PAN).
Renal angiogram (sensitivity 89%, specificity 90%
ANCA are found in around 20% of patients with ‘classic’ PAN
Treatment for tick-borne encephalitis…
Treatment for tick-borne encephalitis is supportive
Management of sickle cell crises
Exchange transfusion if neuro complications
Blood transfusion, rehydration etc
Difference between cluster headaches, paroxysmal hemicrania and hemicrania continua
All trigeminal autonomic cephalalgias…
CH 8/day - every other day
15-180 mins
PH. >5/day,
2-30 min
Responds absolutely to indomethacin
HC. Constant headaches
Responds absolutely to indomethacin
Waking with paralysis, particularly after big carby meal
ECG with flat T waves.
Hypokalaemic periodic paralysis
; rare autosomal dom
HIV positive patient presents with a gradual deterioration in his vision
cytomegalovirus retinitis
Typically CD 4 <200
IV ganciclovir
or its prodrug PO valganciclovir
HIV neuro toxo Vs CNS lymphoma
Toxo more common
CT shows single or multiple ring-enhancing lesions
Mx with sulfadiazine and pyrimethamine
CNS lymphoma single or multiple homogenous lesions (usually single)
Mx steroids and chemo with methotrexate
Main SE to council patients with levetiracetam
behavioural abnormalities and psychotic symptoms
Patient with short history of flu like symp with tender thyroid gland … management
Subacute thyroiditis
Symp control w propranolol
Hetero Vs homozygous familial hypercholesterolemia
Homo usually presents in<30y, chol >15
Hetero >30y, cholesterol > 7.9 mmol/l, with normal triglyceride levels.
best test for differentiating between delirium and dementia?
Confusion Assessment Method (CAM)
- Acute onset and fluctuating course
- Inattention (e.g. Counting from 20-1)
- Disorganised thinking
- Altered levels of consciousness
Needs both 1 and 2, with at least one of 3 or 4
Lofgren’s syndrome
acute form sarcoidosis
characterised by bilateral hilar lymphadenopathy, erythema nodosum, fever and polyarthralgia
Typically young Scandinavian female
Treat with pred
TCA, e.g. amitriptyline, Overdose symptoms and treatment
dry mouth, dilated pupils, agitation, sinus tachycardia, blurred vision
IV bicarb
GBS management
plasma exchange or
IV immunoglobulins
steroids and immunosuppressants have not been shown to be beneficial
Churg Straus Vs wegners
Both sinusitis
Churg asthma eosinophilia
Weg haemoptysis/epistaxis renal failure
Chylothorax Vs pseudochylothorax
chylothorax is high in triglycerides and chylomicrons
Pseudochylothorax is high in cholesterol
Gout triggers
High fructose drinks - tango etc
Beer
Management of sarcoid
Steroids indicated if:
- Hypercalaemia
- Extrapulmonary sarcoid
- CXR stage II/III with moderate to severe symptoms or progressive disease -
PCOS Vs cah
Look up
Skin test for latent TB. Reaction within a day?
Allergic,
Latent TB is a T4 delayed reaction!
But could be because of BCG
Then can do interferon gamma genome
Steele-Richardson-Olszewski syndrome aka
eponymous name for progressive supranuclear palsy
postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
Progressive supranuclear palsy symptoms
postural instability, impairment of vertical gaze, parkinsonism, frontal lobe dysfunction
Term for minor trauma can cause new lesions
Koebner phenomenon
Warts And ALL (warts, autoimmune, AIDS, lichen planus & lichen sclerosis)
Opportunistic infections by JC virus in immunocompromised patient…
Progressive multifocal leukoencephalopathy
Esp patients taking natalizumab
What is gardener’s syndrome
Rare autodom … a variant of familial adenomatous polyposis (<1% of genetic c cancer)
Adenomatous intestinal Polyposis
50% get colon cancer by 39y
Present w change in bowel habits rectal bleeding
Bacterial cause of Q fever
Coxiella burnetti (g neg)
Farmer, fever, transaminitis
Two TIAs in last week mx
Crescendo TIA
So admit and CT head carotid dopplers within 24h
muscle pain and stiffness following exercise
muscle cramps
myoglobinuria
low lactate levels during exercise
McArdle’s disease
autosomal recessive type V glycoge storage
Causing decreased muscle glycogenolsease
Advised to stay active though
features of frontotemporal lobar dementias
Under 65
Relatively preserved memory
Personality change
Insidious onset
Pick’s disease most common type
W hyperorality, disinhibition, increased appetite, and perseveration behaviours
Serotonin syndrome Vs neuroleptic malignant syndrome
SS over hours, increased reflexes, clonus, dilated pupils
NMS over days, predominantly rigidity, decreased reflexes,
most common cause of adult-acquired epilepsy worldwide
Neurocysticercosis
Eggs of the Taenia Solium tapeworm are ingested, oncospheres hatch and migrate to peripheral sites (classically muscles and brain) and become cysticerci, then calcify
mass lesions in the brain ‘swiss cheese appearance’
72 hr Post cardiac arrest, in coma. What is indicator of poor prognosis?
lack of pupillary light / corneal reflex at 72h is a reliable predictor of death
What has best long-term survival benefit w MND
NIV
Riluzole also has modest survival benefit of 2-4 months
Management for hereditary angioedema
IV C1-inhibitor concentrate
Or FFP if that’s not available
Differential for pyrexia of unknown origin and bilateral adrenal hyperplasia
Lymphoma, TB, or histoplasmosis
Histo is diagnosed w FNA and Groccott strain
R sided conductive hearing loss, pulsatile tinitus, wasting on R side of tongue… then develops hoarse voice. Diagnosis?
Glomus Jugulare tumour
tumour of the part of the temporal bone in the skull that involves the middle and inner ear structures
headaches, blurred vision. Bilat swollen discs and diplopia on vertical gaze. Best next step?
CT first to rule out SOL
then can LP
Management of granulomatous polyangitis
Pred
If end organ damage then IV ciclophosq pulsatile
what is brachial neuritis aka neuralgic amyotrophy
unknow aetiology, follows infection, vaccination, surgery, trauma…
Starts with acute onset of unilat (occasionally bilat) severe pain, followed 2/52 later by shoulder and scapular weakness several days later
can be axillary sensory loss
Good prog, unless phrenic nerve involvement
age of Friedreich’s ataxia and Ataxia telangiectasia
10-15y
telangiectasia: <5y
what is cataplexy
strong emotions causing loss of voluntary muscle tone
Found in 70% of narcoleptics
HLA DQB1*0602 is found in 95% of pt with both narcolepsy and cataplexy
No driving until “control of symptoms”
recurrent bacterial infections and low IgA IgG
common variable immunodef
B cell maturation defect
What is Bickerstaff’s encephalitis?
symmetrical opthalmeplegia, ataxia, altered consciousness, hyper-reflexia
Similar to Miller Fisher (also anti GQ1b antibodies) and follows URTI, but Miller fisher has Areflexia and normal consciousness
Tx steroids IgG and plasma exchange
What is BRASH syndrome?
Viscous cycle of Bradycardia, Renal failure, AV nodal blocking medication, Shock, Hyperkal
feat of haemochromatosis
fatigue, ED, arthralgia
bronzing of skin
DM
Chronic liver disease, hepatomegaly
Cardiac failure (2nd to dilated cardiomyopathy)
Hypogonadism (2nd to cirrhosis and pituitary dysfunction - hypogonadotrophic hypogonadism)
episodic inflammatory arthritis (especially of the hands)
chondrocalcinosis and pseudogout
timescale of HIV seroconversion
occurs 3-12 weeks after infection
how is Hep B and hep C commonly transmitted in uk
anal intercourse and IVDU respectively
Gonoccal arthritis vs reactive
reactive is large-joint monoarthritis w temp and CRP response
gonococcal arthritis is usually a migratory polyarthritis
sore throat, pyrexia, adherent grey membrane over his soft palate and tonsils
membrane characteristic of:
diphtheria
Vincent angina can ALSO cause a pharyngeal membrane but there is usually also severe local tissue destruction
feat of myotonic dystrophe
inherited, but features develop around 20-30yr
bilateral ptosis
facial weakness
distal weakness
Duchenne’s vs becker’s vs myotonic dystrophes - younger?
Duchenne’s <5y
Becker’s >10y (intellectual impairment much less common)
Myotonic dystrophe 20-30yr
Acephalgic migraine
Migraine without headache
Up to 38% of migraineurs experience migraine attacks without and with a headache, while 4% of migraineurs exclusively experience migraines without headaches
pseudo dementia
depression-related
memory issues, deficits in executive functioning, and deficits in speech and language
meningitis complicating an ear infection
This clinical situation is nearly always due to:
Streptococcus pneumoniae
What CD4 count do you expect if your have PCP
<200 for PCP or mycobacterium avium
what causes lateral medullary syndrome?
AKA Wallenberg’s syndrome
infarction of the lateral part of the medulla
by blockage of vertebral artery or the posterior inferior cerebellar artery
… thrombosis or dissection
presentation of lateral medullary syndrome?
ipsilat Horner’s syndrome, laryngeal, pharyngeal, and palatal hemiparalysis
and cerebellar involvement (ataxia, nystagmus)
post elective cholecystectomy w AF, IHD. When do you restart warfarin?
usually resumed 12 to 24 hours after surgery
Evidence points towards starting warfarin at the USUAL dosage
w bridging LMWH if high risk
presentation of acute intermittent porphyria
abdominal and neuropsychiatric symptoms in 20-40 year old females
abdo pain, motor neuropathy, depression
urine turns deep red on standing
urine turns deep red on standing
Acute intermittent porphyria
increasingly blurry vision. Fundoscopy shows pale optic discs, microaneurysms and blot haemorrhages
Drug cause?
Ethambutol, known to cause optic neuritis
inheritance of Duchenne and Becker’s muscular dystrophies
X-linked recessive
feat of Myotonic dystrophy
bilat ptosis myotonic facies (long, 'haggard' appearance) Distal weakness in DM1 Proximal weakness in DM2 cataracts
Strongyloides stercoralis on serology. Management
Ivermectin
man in 60s gets 6month hx of progressive lower limb weakness w quadriceps and finger/wrist flexors weakness. CK 830
Inclusion body myositis
progressive late onset myopathy
Temporarily headache, painless loss of vision, branch retinal artery occlusion
Diagnosis
Temporal arteritis
IV Methylprednisolone
Patient with CLL.
Long bone pain and prox myopathy
Hypophosphatemia
Oncogenic osteomalacia
Also in adenocarcinoma
Tx vit d metabolites and Phos replacement
Normal pressure hydrocephalus
Cognitive impairment
Incontinence
Apraxic gait
(Unlike multisystem atrophy, postural hypotension is rare) also MSA is ataxic gait
what cancers do you see Tumour lysis syndrome in?
3-7 days after chemo
for high-grade lymphomas and leukaemias
Can get autolysis too but v rare
Remember uric acid stones are Radiolucent
bloods in tumour lysis syndrome
RAISED uric acid
RAISED potassium
RAISED phosphate
LOW calcium
or 25% change
pt w neuroendocrine tumour on palliative chemotherapy becomes increasingly SOB over months.
Flushing, diarrhoea, heart failure.
Diagnosis
Carcinoid heart syndrome causing Tricuspid regurge
could be Superior vena cava obstruction
presentation of antifreeze OD
Ethylene Glycol
similar to alcohol… confusion, slurred speech, dizziness, renal failure
metabolic acidosis with high anion gap and high osmolar gap
Really high lactate but may glycolate being misinterpreted as lactate by machine
management of antifreeze OD
fomepizole, an inhibitor of alcohol dehydrogenase, is now used first-line in preference to ethanol
Same tx as for methanol OD
Adult, tacy at 180 VT, bp 80, conscious. Management
Signs of shock so needs synchronised DC cardioversion x3 attempts
but needs sedating first so anaesthetics
Could start Amiodarone before anaesthetics show up (which is next step)
Stopping NAC 12h bags?
after 3 bags, can stop if:
INR <1.4
and ALT under double top/ double admission
After 4 more stop if:
INR <=1.3
Or INR is <3.0 and falling towards normal on two consecutive blood tests
New definition of sepsis
Suspected infection
and acute increase of >=2 SOFA points
SBP ≤ 100 mmHg
≥ 22 breaths/min
GCS ≤ 14
septic shock definition
Sepsis (suspected infection and acute increase >=2 SOFA points)
Lactate >2
Vasopressor req to maintain MAP >65
…despite 30ml/kg in first 3hr
ewing’s sarcoma
primary bone tumour, particularly in male children/adolescents, severe pain in pelvis/longbones
Anaemia is poor prognostically
x-ray shows ‘onion skin’ appearance
management of cyanide poisoning
hydroxocobalamin IV amyl nitrite (inh), sodium nitrite IV, sodium thiosulfate IV
Can give IV dicobalt edetate if v unwell
features of yellow nail syndrome
triad of primary lymphoedema, recurrent pleural effusions, dystrophic yellow nails
often have bronchiectasis and sinusitis
indications of steroids in sarcoidosis
hypercal
eye, heart, or neuro involvement
CXR stage 2 or 3 and symptomatic
BHL + interstitial infiltrates
or diffuse interstitial infiltrates only
IVDU, cerebral abscess, mx
would be fluclox but high rate of MRSA
so linezolid (good cover and crosses BBB)
mx of osteomalacia
alfacalcidol
pt on the pill presents w headache , double vision, reduced sensation to light touch on the left forehead and cheek
Cavernous sinus thrombosis
CN 6th nerve damage typically occurs before 3rd & 4th
HIV pregnancy and breast feeding advice
vaginal delivery is recommended if viral load <50 copies/ml at 36/40
in the UK all women should be advised not to breast feed
When do you treat paracetamol overdose
If staggered (taken over longer than an hour), or unsure of time. Or if level is above 100mg/l at 4hr, or 15 at 15
30 yr old woman presents with chronic abdo pain, psychiatric issues like depression, and motor neuropathy. Mum had same. Diagnosis?
Acute intermittent porphyria
Auto dom
Urine turns deep red on standing
Urine turns deep red on standing
Acute intermittent porphyria
most common bacterial cause of meningitis post neurosurgery
staphylococcus epidermis
stroke thrombolysis absolute contraindications
absolute:
- Seizure at onset
- LP within 1/52
- GI haemorrhage within 3/52
- Stroke/brain injury in last 3months
- Any previous ICH
- Active bleeding
- Pregnancy
- Oesophageal varices
- Uncontrolled BP >200/120
