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Waterhammer vs CollapsingWaterhammer pulse = pulse felt across your fingers when lifting the arm of a patient with a hyp...
05/02/2023

Waterhammer vs Collapsing

Waterhammer pulse = pulse felt across your fingers when lifting the arm of a patient with a hyperdynamic circulation (pregnancy, hyperthyroidism etc)

This is not identical to the pulse felt when the arm is lifted in a patient with Aortic regurgitation.

AR = The pulse initially hits all the fingers of holding hands, with each beat hitting progressively fewer fingers (collapsing away)

This is due to the arterial blood in the arm being emptied back into the ventricle through the incompetent aortic valve when the arm is lifter, initially increasing stretch and stroke volume for a few beets.

Collapsing can also describe the characteristic of the individual pulse beat in AR

05/02/2023

I've noticed that lots of people have started using the term "past pointing" incorrectly when they actually mean "intention tremor"

Intention tremor = wobbly finger when finger outstretched in cerebellar syndrome (and when returning to touch nose)

Past pointing = accidentally pointing at a ghost image by a patient who has new diplopia

If you are demonstrating cerebellar syndrome, use the term intention tremor

03/02/2023

Nystagmus

Towards the side of the cerebellar lesion
Away from the side of the 8th nerve lesion
Upwards = Brainstem lesion
Downwards = Foramen Magnum

Vertical always central
Horizontal can be peripheral

If a patient has diplopia, it is the outermost image that is the abnormal image.Cover each eye in turnIf the inner image...
03/02/2023

If a patient has diplopia, it is the outermost image that is the abnormal image.

Cover each eye in turn

If the inner image disappears, you have covered the good eye.
Cover the alternate eye, the outermost image should now disappear.

If the same image disappears then the diplopia is non-organic

01/02/2023

Causes of MAHA

DIC (most common)
TTP (elderly neuro) and HUS (young and renal)
HELLP (Pregnant)
Malignant hypertension

Finding on blood film (for exams)Pencil cells = iron deficiencyTear drops = MyelofibrosisHeinz bodies = G6PDSmear (smudg...
01/02/2023

Finding on blood film (for exams)

Pencil cells = iron deficiency
Tear drops = Myelofibrosis
Heinz bodies = G6PD
Smear (smudge) cells = CLL
Howell Jolly bodies = missing spleen
Helmet / fragmented cells = MAHA
Burr cells = Uraemia
Basophilic stippling = Lead poisoning

Wegener = C-ANCA = pR3Churg & MPA = P-ANCA = MPOPAN = ANCA -'veWegener's new name GPA (Granulomatosis with polyangiitis)...
31/01/2023

Wegener = C-ANCA = pR3
Churg & MPA = P-ANCA = MPO

PAN = ANCA -'ve

Wegener's new name GPA (Granulomatosis with polyangiitis)
Churg Strauss new name eGPA (Eosinophilic Granulomatosis with polyangiitis)

Ulcerative colitis = p-ANCA
Crohn's = ASCA

Summary of abnormalities on EMGIncreased amplitude with repeated stimulation = LEMSDecreased amplitude with repeated sti...
30/01/2023

Summary of abnormalities on EMG

Increased amplitude with repeated stimulation = LEMS
Decreased amplitude with repeated stimulation = Myasthenia
Divebomber = Myotonic dystrophy
Reduced amplitude and duration with fibrillation = Myositis

There is hairy Cushing's syndrome and smooth Cushing's syndromeACTH driving Cushing's syndrome also promotes the secreti...
29/01/2023

There is hairy Cushing's syndrome and smooth Cushing's syndrome

ACTH driving Cushing's syndrome also promotes the secretion of androgens making you hairy (pituitary or ectopic)

Adrenal or exogenous steroids suppress ACTH, reducing androgens causing loss of hair - resulting in a smooth (hairless) Cushing's syndrome

Factors 10 9 7 2 are reduced by WarfarinFactprs 10a 9a 2a are inhibited by IV HeparinThe only numberical di...
29/01/2023

Factors 10 9 7 2 are reduced by Warfarin
Factprs 10a 9a 2a are inhibited by IV Heparin

The only numberical difference in their site of action is factor 7 which is why Heparin doesn't affect the extrinsic clotting cascade

28/01/2023

Loop diuretics work on the thick ascending limb as Na-K-2Cl cotransporters

It is more simple than it sounds

They pump out NaCl (sodium chloride) & KCl (potassium

This is made to sound more sexy by putting the Na and K on one side of its name and the 2 clorides on the other.

28/01/2023

limited cutaneous systemic sclerosis = most strongly associated with pulmonary hypertension (limited & lung to remember)
diffuse cutaneous systemic sclerosis = most strongly associated with sclerodermic renal crisis (like malignant hypertension)

limited cutaneous systemic sclerosis = new name for CREST

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