Volume 7, Issue 3, Pages 105 – 150 (2008)

Acute Medicine: A Practical guide to the management of medical emergencies

Book Review, Volume 7, Issue 3, Pages 105 - 150 (2008)

Any junior doctor navigating the early stages of training will recognise the need to develop the ability to crystallise the essence of a clinical case with a few succinct questions and directed examination, enabling subsequent investigations and treatments to be well directed. Whilst the acquisition of this experience requires hard yards on the shop floor, this book makes an excellent companion for the junior doctor in the Emergency Department or the Admissions Unit. It offers an accessible and concise guide to the management of acute medical problems, with succinct ‘aide memoires’ for focussed assessment.

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Picture Quiz: A Case of Acute Hepatitis – Answers

Picture Quiz, Volume 7, Issue 3, Pages 105 - 150 (2008)

His syphilis serology was positive
– Initial IgG ELISA test positive
– TPHA positive
– IgM positive and RPR (128) positive confirm recent infection

All other screening tests (including viral hepatitis and HIV test) were unremarkable, hence a diagnosis of secondary syphilis causing hepatitis was made. Further examination revealed a healing chancre on the shaft of his penis and pustules around the anu.

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Picture Quiz: A Case of Acute Hepatitis

Picture Quiz, Volume 7, Issue 3, Pages 105 - 150 (2008)

A 19 year old male with no previous medical history presented to hospital with an eight day history of jaundice and general malaise. He was homosexual with a history of unprotected sex with multiple partners over the last two years. He drank heavily in binge sessions and occasionally recreational drug use, cocaine and ecstasy but he had never injected. There was no history of recent travel. He had never had a previous HIV test or Sexual Transmitted Infection screen.

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British Society of Echocardiography Accreditation – The ‘Gold Standard’ For Acute Medicine

Viewpoint, Volume 7, Issue 3, Pages 105 - 150 (2008)

We read with interest to the article written by Kevin Fox 1 and wholly support the notion that acute medical trainees who wish to undertaken echocardiography within the medical admissions unit (MAU) should achieve British Society of Echocardiography (BSE) accreditation. I was one of the first trainees in acute medicine to undertake training in echocardiography; despite considerable competition from cardiology registrars as well as resistance from the physiology department I am now close to attaining the BSE Trans Thoracic Echocardiography accreditation.

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Acute Intermittent Porphyria: Some Diagnoses are Only Made If Thought of

Case Reports, Volume 7, Issue 3, Pages 105 - 150 (2008)

A 20-year-old Asian, female, student nurse of thin body habitus (Body Mass Index 16.5) but otherwise previously well had numerous admissions to our centre under a variety of surgical sub-specialities over a 5-month period. Each month, coinciding with menses, she complained of non-specific abdominal discomfort in the absence of any other symptoms. With the exception of the presence of a sinus tachycardia coupled with incidental hyponatraemia full physical examinations and routine baseline investigations were unremarkable.

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What becomes of the broken-hearted? A typical case of Takotsubo cardiomyopathy

Original Articles, Volume 7, Issue 3, Pages 105 - 150 (2008)

Takotsubo cardiomyopathy (TC), or apical ballooning syndrome (ABS), is becoming an increasingly recognised entity. Usually preceded by emotional stress, it is characterised by chest pain associated with ST-segment elevation on the 12-lead electrocardiogram (ECG), elevated cardiac biomarkers, and reversible left ventricular (LV) apical hypokinesia, making it an important differential diagnosis for ST-segment elevation myocardial infarction (STEMI). We present a typical case of TC initially misdiagnosed and treated as a STEMI, fortunately with no adverse consequences.

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Cerebral Nocardiosis in a patient with Waldenstrom’s Macroglobulinaemia

Original Articles, Volume 7, Issue 3, Pages 105 - 150 (2008)

Nocardiosis is caused by nocardia species, a Gram positive aerobic filamentous bacillus. It is ubiquitous in the environment and often presents as pulmonary disease in more than 70% of patients.1 Dissemination of the disease may manifest as brain abscesses, and is reported to account for approximately 2% of all brain abscesses.

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Acute Painless Jaundice: Assessment and Management

Original Articles, Volume 7, Issue 3, Pages 105 - 150 (2008)

The most common presentation of liver and biliary disease is jaundice, and most acute medical teams will encounter several jaundiced patients over time. Some of these patients will be extremely unwell, and a systematic approach will enable all doctors to manage such patients correctly.

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Tuberculosis of the central nervous system: Recognition, diagnosis and treatment in a low-prevalence country

Original Articles, Volume 7, Issue 3, Pages 105 - 150 (2008)

Tuberculosis (TB) is one of the greatest threats to global public health, with 9.2 million new cases in 20061 and has become increasingly common in the UK. Central nervous system (CNS) infection with Mycobacterium tuberculosis (MTB) is relatively rare but is associated with a serious risk of neurological morbidity or death. Delays in diagnosis worsen prognosis and even with anti-tuberculous therapy up to 30% of tuberculous meningitis (TBM) patients may die.2 TBM and tuberculomas can mimic other CNS pathologies. Careful analysis of the clinical features, CSF examination and pragmatic use of diagnostic tests can aid the diagnosis. Prolonged anti-tuberculous treatment is required and presumptive treatment should not be delayed for microbiological confirmation of the disease.

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