New content quiz October 2015

Gilbert’s syndrome is a hereditary condition with incomplete penetrance characterised by intermittent unconjugated hyperbilirubinemia in the absence of hepatocellular disease or haemolysis. It is usually asymptomatic. It is present in 5% to 10% of Western European populations and causes a 70% reduction in the liver’s ability to conjugate bilirubin that can lead to intermittent episodes of nonpruritic jaundice. Episodes can be caused by many different factors including starvation, infection, strong exertion and drugs. The serum bilirubin is usually < 70µmol/L and conjugated bilirubin is < 20% of the total bilirubin fraction. No specific management is required for most patients. It is associated with an increased risk of gallstones, adverse reactions to multiple drugs, including chemotherapy and a reduced risk of cardiovascular disease. (link)

Angiodysplasia involves the right side of the colon most commonly, however lesions of small bowel can occur. Bleeding uncommonly severe and is associated with: aortic stenosis (may improve following valve replacement); renal failure; LV assist devices. (link)

Hydralazine is an arteriolar vasodilator that can produce a Lupus like syndrome when used chronically. Labetalol has alpha and non selective beta antagonist properties. Esmolol is a beta 1 selective antagonist. GTN is predominantly a venodilator and fenoldopam is a D1 receptor antagonist. (link)

Group A Streptococci-causes vast majority of bacterial pharyngitis and Fusobacterium necrophorum may be almost as common as Group A Strep in young adults. Less common causes include: Group C and G Streptococci; Arcanobacterium haemolyticum; Mycoplasma; Chlamydia; Anaerobic bacteria (especially in chronic tonsillitis). (link)

Systemic corticosteroids in hospitalised patients with CAP probably reduces morbidity in most patients and reduces mortality in those with more severe disease. (link)

In inhalational anthrax typical bronchopneumonia or lobar consolidation does not occur. It usually produces focal haemorrhagic necrotising lesions analogous to the Ghon focus associated with TB. Thoracic lymphadenitis, haemorrhagic mediastinitis, and pleural effusions may also be present. (link)

Sterile pyruria is the persistent finding of white cells in the urine in the absence of bacteria, as determined by means of aerobic laboratory techniques. It accounts for approximately 15% of pyuria in women and 2.5% in men. The most common causes  are partly treated urinary tract infections and urinary catherisation. Other causes include sexually transmitted diseases,TB, funghi, schistosomiasis, inflammatory conditions and  renal infarction. (link)

The usual first line investigation of a patient with suspected aortic dissection is a CT aortogram as it is equally sensitive and specific as a TOE, but more widely available than TOE and less invasive than aortography. D dimer is probably highly sensitive, but if you suspect aortic dissection you need to make the diagnosis as soon as possible, and you also need to know what type it is. (link)

Calcitonin may reduce the pain from osteoporotic crush fractures, but has little effect on malignant bone pain. (link)

NT-proBNP-levels > 300 nanog/L are 90-99% sensitive and 65-75% specific (link)