The four types of dizziness in clinical medicine
A 24 year old woman with a positive pregnancy test is seen in the EPAU with three days of lower abdominal pain. A transvaginal ultrasound shows she is 5 weeks…
Making an impact on impacted faeces
A 80 year old lady is admitted with abdominal distension and difficulty breathing. She is found to have ascites secondary to an ovarian malignancy. Her ascites are drained. One day…
How to convince a surgeon to accept a RIF pain referral
I just love gyane on call. A 43 year old woman is brought to A&E complaining of severe right iliac fossa pain for the past day. A pregnancy test is…
Using the CRP on inpatients
“Stay in till tomorrow to recheck the CRP. If it goes down to less than 100 he goes home.” “It’s day 2 post op. The CRP is 167 from 67 the day…
Cerebral venous thrombosis is a real headache
90% of headaches in pregnancy are migraine or tension-type headaches. Unfortunately, pregnancy is also a time of risk for two serious causes – cerebral sinus thrombosis and idiopathic intracranial hypertension…
Things I learnt today from MRCP Part 2 revision (Day 1)
From the ESC and some other places: Peripartum cardiomyopathy needs heparin (prophylactic dose if ejection faction > 30%, treatment dose if less than 30% or if AF or previous clot)….
Treating insomnia naturally without medication
A lady in her early 50s had come for a repeat of her zopiclone. She had been on it for years. When I suggested a trial of cutting down, she…
Mildy deranged LFTs in the GP setting
A man in his mid 30s was invited to make a routine appointment to discuss his LFTs. 6 months ago Now Reference range Alanine Transferase 67 132 < 40 IU/L…
Antibiotic associated diarrhoea: My new primary care strategy
A woman in her mid 50s had been prescribed doxycycline 5 days ago for persistent upper respiratory symptoms. She returned to us because of watery diarrhoea since yesterday. There was…
A suggested strategy for ‘Could be a PE but probs not’
A super simplified yet evidence-based approach to using the d-dimer in PE Q1. Is PE your top differential? If yes, do a V/Q or CTPA. Wells et al suggested that…