Day: January 9, 2024

#Clinical Haematology

Lymphadenopathy

By Dr. Ahmed Hafez

Overview Lymphadenopathy essentially refers to lymph nodes with abnormal consistency or size. Lymphadenopathy is a very broad term that simply refers to the disease of lymph nodes. The term is used to represent a change in size or consistency of a lymph node. The two most common causes of lymphadenopathy are infection and malignancy. Lymphadenopathy may be peripheral or visceral: Peripheral: lymph nodes located in areas close to the skin that can be palpated when enlarged (e.g. neck, axilla, groin) Visceral: lymph nodes located inside the body at deep locations, usually in association with major organs (e.g. mesenteric lymph nodes,

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#Statistics

Data presentation

By Dr. Ahmed Hafez

Summary Data can be binary, nominal, ordered, discrete quantitative, or continuous quantitative. Graphs include bar-charts, pie-charts, histograms, box-and-whisker plots and scatter diagrams. The type of graph used should be chosen according to the type of data being displayed. Be aware that graphs may be presented in misleading ways. Furthermore, graphs can be symmetrical, positively skewed or negatively skewed. Types of average include the mean, median, and mode. Measures of spread include the range, interquartile range, variance, and standard deviation. Means and measures of spread should be chosen according to the type of data being summarised and some measures are susceptible

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#Pharmacology

Antiarrhythmics

By Dr. Ahmed Hafez

Vaughan-William’s classification Anti-arrhythmics are drugs that modify cardiac conduction, they are used to treat arrhythmias and are classified according to the Vaughan-William’s system. This classification divides these drugs into four classes according to their effects on cardiac action potential. Anti-arrhythmics have complex actions and classes may overlap. It is important to note, that this classification system has become increasingly inadequate with improved understandings of drug mechanisms and development of new antiarrhythmics.     Arrhythmogenesis To understand the action of the antiarrhythmics it helps to understand how arrhythmias may develop. Arrhythmias are disorders of rate and rhythm of the heart, which

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#Pathology

Ascitic fluid

By Dr. Ahmed Hafez

Overview Ascites refers to the presence of pathological fluid within the abdominal cavity. In men, no fluid should be present. In women, up to 20 mls may be considered normal depending on the timing of their menstrual cycle. Ascites is most commonly associated with liver disease. In this context, ascites develops due to portal hypertension. This refers to increased pressure within the portal venous system that drains blood from the gastrointestinal tract to the liver. Other causes of ascites are broadly due to local infiltration (e.g. tumour) of the peritoneal lining, inflammation or infection.     Aetiology Ascites can be

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#Histories

Basic history

By Dr. Ahmed Hafez

Introduction The art of medicine is to determine why a patient has sought help. The key skills to help establish the underlying cause of a patients’ symptoms (the diagnosis) is based on talking to the patient (the history), examining the patient (the examination) and requesting testslike bloods and x-rays (the investigations). The information gathered from the history and examination is used to form a hypothesis of the possible underlying diagnosis. Investigations can then be used to either confirm or refute this diagnosis. Some diagnoses can be made just by talking to a patient, while others are reliant on a specific

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#ECGs

How to read an ECG

By Dr. Ahmed Hafez

Introduction Conduction through the heart is dependent on pacemaker cells, which are organised into key structures. The heart is a dual pump that sits at the centre of the cardiovascular system. It is composed of both contractile cells and autorhythmic cells (also known as pacemaker cells). Approximately 1% of cardiac tissue is composed pacemaker cells, which are organised into key structures and can undergo spontaneous depolarisation. Depolarisation refers to the electrical changes that occur within a muscle to allow it to contract. The heart is essentially one big muscle that can contract by itself. We can detect these electrical changes,

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#Consepts

Confirmation of death

By Dr. Ahmed Hafez

Overview Confirmation of death is an important part of healthcare practice. The confirmation of death is an essential part of practice within both the community and hospital setting. In 2008, the Academy of Royal Medical Colleges issued a generalised code of practice for the confirmation of death. Death may occur from: Irreversible cessation of brain-stem function (i.e. brain-stem death) Following cessation of cardiorespiratory function (including failed resuscitation) The confirmation of brain-stem death (i.e. the heart and lungs can only be maintained by artificial ventilation) is advanced and has to be carried out by at least two medical practitioners (minimum one

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#ABG

ABG interpretation

By Dr. Ahmed Hafez

Overview Interpretation of an arterial blood gas is an essential skill required by all doctors and most healthcare professionals. In simplistic terms, an arterial blood gas (ABG) tells us about three main things: Oxygenation: measurement of oxygen within the blood. Ventilation: process of respiratory function (i.e. breathing). Acid-base balance: the control of pH. To enable us to interpret oxygenation, respiratory function and acid-base balance, an ABG analyser gives us key bits of information. This includes the pH, partial pressure of oxygen, partial pressure of carbon dioxide and calculated bicarbonate. Key components pH (normal range 7.35-7.45): refers to the acidity or

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#Psychiatry

Acute stress reaction

By Dr. Ahmed Hafez

Introduction An acute stress reaction refers to intense, or prolonged, mental or psychological distress that can develop after exposure, or in response, to a stressful event. Many people who experience a traumatic event will struggle with negative emotions, thoughts, and memories of the event. In the first month following the traumatic event, they may experience an acute stress reaction, symptoms of which include: Intrusion symptoms: reexperiencing the traumatic event (memories, flashbacks, nightmares). Negative mood: inability to experience positive emotions, such as happiness. Dissociative symptoms: an altered sense of one’s surroundings or oneself, difficulty remembering the trauma. Avoidance symptoms: avoidance of

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#Paediatrics

Acute epiglottitis

By Dr. Ahmed Hafez

Overview Acute epiglottitis refers to inflammation of the epiglottis and surrounding supraglottic mucosa. It can be a life-threatening condition due to airway obstruction. Thankfully, acute epiglottitis is now rare in children due to the introduction of the Haemophilus influenzae type B (Hib) vaccination as part of the routine immunisation programme. In adults, the incidence is estimated at 1-4 per 100,000 people. In children, the median age at presentation has increased to 6-12 years (traditionally affected children 2-5 years old). Children who have not been vaccinated are at particular risk.     Basic anatomy The epiglottis is a thin layer of

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#Ophthalmology

Angle-closure glaucoma

By Dr. Ahmed Hafez

Introduction Glaucoma refers to a collection of disorders resulting in progressive optic neuropathy in which raised intraocular pressure is typically a key factor. Glaucoma Glaucoma is a common pathology affecting the eye that untreated can result in significant loss of vision. Worldwide it is the leading cause of irreversible blindness with 66 million affected, 12.5 million of whom are blind. In the UK it is responsible for around 10% of those registered blind. There are two major forms of glaucoma (and a related condition ocular hypertension): Open-angle glaucoma: characterised by a normal angle between the iris and cornea. It is

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#Vascular

Abdominal aortic aneurysm

By Dr. Ahmed Hafez

Definition Abdominal aortic aneurysm (AAA) is defined as an abnormal dilatation of the abdominal aorta with a diameter greater than 3 cm. It is a relatively common aortic pathology that results in significant amounts of morbidity and mortality. Between 1-2% of men undergoing NHS screening (over the age of 65) will be found to have a AAA. The vast majority are infrarenal (i.e below the origin of the renal arteries). Risk factors AAA may be considered a degenerative condition of the aorta though its aetiology is not fully understood. A number of risk factors have been shown to be associated

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#Urology

Acute bacterial prostatitis 

By Dr. Ahmed Hafez

Introduction Acute bacterial prostatitis refers to a an infection involving the prostate that may cause significant systemic upset. It tends to present with urinary symptoms, lower back or pelvic pain +/- symptoms of systemic infection. Urinary pathogens are often implicated, commonly Escherichia coli. Less commonly sexually transmitted infections are isolated as the cause.     Aetiology E.coli is the most commonly isolated pathogen in acute bacterial prostatitis. Pseudomonas aeruginosa, Klebsiella, Enterococcus and Proteus may all be causes. Sexually transmitted infections, Chlamydia trachomatis and Neisseria gonorrhoea, are less commonly isolated. There are a number of specific scenarios to consider: Recent urethral

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#Obstetrics

Antepartum haemorrhage

By Dr. Ahmed Hafez

Introduction Obstetric haemorrhage, which includes both antepartum and postpartum haemorrhage, is the leading cause of maternal death worldwide. Within the UK, maternal death from obstetric haemorrhage is uncommon, but it still causes approximately 4-7 deaths per year. Obstetric haemorrhage is a common cause of both maternal and neonatal morbidity. Antepartum haemorrhage (APH) complicates approximately 3-5% of all pregnancies. It is estimated that up to 20% of very preterm babies are born in association with an APH. APH is defined as any vaginal bleeding from 24 weeks gestation until delivery. Bleeding that occurs within the first 24 weeks of gestation is

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#HIV

Antiretroviral therapy

By Dr. Ahmed Hafez

Introduction Antiretroviral therapies (ART) have revolutionised HIV care, transforming what was once an almost invariably fatal illness into a treatable chronic disease. ARTs enable those with HIV, in many cases, to live near-normal lives (depending on factors such as stage at diagnosis). There are six major classes of medication; entry inhibitors, nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), integrase inhibitors, protease inhibitors and post-attachment inhibitors. The options available allow for changes to be made in light of resistance patterns, experienced side effects and personal risk factors. As a general rule, regimens consist of: Two nucleoside reverse transcriptase

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#Gynaecology

Bartholin gland cyst

By Dr. Ahmed Hafez

Overview A Bartholin gland cyst refers to cystic dilatation of one of the greater vestibular glands due to obstruction. The Bartholin glands, also known as the greater vestibular glands, form part of the vulva (external female genitalia). A common abnormality of these glands is the formation of a cyst due to obstruction. A Bartholin gland cyst may become infected forming an abscess. Cysts can be small and asymptomatic or large and cause discomfort. Infection of the Bartholin glands often causes severe pain and swelling due to abscess formation. Management depends on the cyst size and presence or absence of abscess

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#GUM

Anogenital herpes

By Dr. Ahmed Hafez

Overview Anogenital herpes is caused by herpes simplex virus 1 & 2 and leads to painful ulcerated genital lesions. Anogenital herpes is characterised by multiple, painful, ulcerated genital lesions. They arise as small vesicles that progress to pustules, which subsequently ulcerate and crust over. Anogenital herpes can be caused by herpes simplex virus 1 (HSV1) or herpes simplex virus 2 (HSV2), which are both part of the larger family of human herpesviruses (HHVs). This family also includes varicella-zoster virus, Epstein-Barr virus and cytomegalovirus.     Epidemiology Worldwide there are over 23 million cases of HSV infection per year. HSV-1 is

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#Biochemistry

Familial hyperlipidaemia 

By Dr. Ahmed Hafez

Overview Familial hyperlipidaemia refers to the inheritance of a single (or multiple) genetic variant(s) that lead to elevated lipid levels. Familial hyperlipidaemia is also known as primary hyperlipidaemia. It refers to the inheritance of single or multiple genetic variants that cause an abnormal elevation in serum lipids. These lipids include total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG). If there is a single genetic variant (i.e. mutation) this is known as a monogenic disease. If there are multiple genetic variants that all contribute to the development of the condition this is known as a polygenic disease. The pattern

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#Anaesthetics

Anaesthetic pre-assessment

By Dr. Ahmed Hafez

Introduction All patients will be reviewed by an anaesthetist prior to their surgery. This generally occurs on the morning of the operation by the anaesthetist who will be looking after the patient. It is a time for the anaesthetist to undertake a systematic review of the patient, review any investigations and arrange urgent ones if essential to proceeding with surgery safely. It is also an essential time to explain the anaesthetic approaches available and explain the relevant benefits and risks of each to allow a shared decision to be reached with informed consent.     Elective vs emergency Pre-op assessment

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#Plastics

Basal cell carcinoma

By Dr. Ahmed Hafez

Summary Basal-cell carcinoma (BCC) is a slow-growing, locally invasive, malignant epidermal (basal layer) skin tumour. Typically, a slow-growing skin lesion (over months / years) which commonly occurs on sun-exposed areas of the body. Eighty percent occur on the head and neck. BCC is the commonest form of skin cancer. It is 4-5x more common than squamous cell carcinoma (SCC). They generally affect middle-aged/elderly individuals, unless there is a genetic susceptibility. BCCs are locally destructive and rarely metastasize. Clinical examination typically demonstrates a flesh- or pink-colored lesion with rolled edges, ulceration and telangiectasia (small blood vessels). Treatment is usually by surgical

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#Orthopaedics

Ankle fractures

By Dr. Ahmed Hafez

Overview Ankle fractures are common lower limb fractures often occurring due to low-energy torsional trauma. They affect women more than men, most commonly those aged 30-60. Ankle fractures account for around 9% of fractures presenting to accident and emergency, representing a significant portion of the trauma workload. Treatment involves restoration of normal anatomical alignment. This may involve conservative management with a walking boot or cast, or involve surgical fixation. Attention must be payed to the risk of venous thromboembolism (VTE) and prophylaxis given where appropriate. Anatomy The ankle is a hinge joint, formed by the malleoli & talus. It is

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#Neurosurgery

Acute subdural haematoma

By Dr. Ahmed Hafez

Definition Subdural haematoma is a collection of blood in the subdural space. Subdural haematoma (SDH) refers to a collection of blood in the subdural space. This is situated underneath the dura and above the arachnoid mater meningeal layers. There are several classifications of SDH: Acute (ASDH): bleeding occurring in the last 1-3 days. Chronic (CSDH). blood that has usually been present for > 3 weeks. Subacute: bleeding that occurs between 4 days and 2-3 weeks Acute on chronic: chronic haematoma that may expand secondary to recurrent bleeding     Aetiology The most common cause of ASDH is trauma. ASDH is

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#Hepatobiliary

Acute pancreatitis

By Dr. Ahmed Hafez

Introduction Acute pancreatitis refers to an acute inflammatory process involving the pancreas. Pancreatitis occurs due to the uncontrolled release of activated pancreatic enzymes within the pancreas resulting in autodigestion. Patients may suffer a spectrum of disease from mild abdominal discomfort to multi-organ failure. Pancreatitis has an annual incidence of 13-45 cases per 100,000, with trends showing that it is becoming more common. It tends to occur more in men and is commonly secondary to gallstones or alcohol misuse.     Aetiology Alcohol misuse and gallstones are the most common causes of acute pancreatitis. Alcohol misuse and gallstones are responsible for

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#General Surgery

Abdominal incisions

By Dr. Ahmed Hafez

Overview A surgical incision refers to a cut made through the skin to access deeper tissue or facilitate an operation. An abdominal incision refers to a surgical cut made anywhere on the abdomen. This enables access to deeper tissue to facilitate an operation by gaining access to the intra-abdominal or intra-pelvic cavities. There are a number of characteristic incisions that are completed on the abdomen to facilitate open surgery. Many of these have eponymous names. Knowledge of abdominal incisions is important for exams. Kocher This is a subcostal incision that is completed to gain access to the upper abdomen. A

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#ENT

Acoustic neuroma

By Dr. Ahmed Hafez

Overview An acoustic neuroma is a benign Schwann-cell derived tumour, which commonly arises from the eight cranial nerve. An acoustic neuroma, also known as a vestibular schwannoma, is a benign intracranial tumour that is derived from Schwann cells that are one of the major supporting nerve cells in the peripheral nervous system. It is typically a slow growing tumour that arises from the eighth cranial nerve supplying the inner ear. This cranial nerve, also known as the vestibulocochlear nerve, has important functions in both hearing and balance. An acoustic neuroma is typically unilateral and leads to unilateral sensorineural hearing loss

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#Breast surgery

Breast cancer

By Dr. Ahmed Hafez

Introduction Breast cancer is the most common malignancy affecting women in the UK. It may be diagnosed during screening or patients may present with a breast (or axillary) lump. Pain, skin and nipple changes may also prompt presentation. On occasion, patients will present with symptoms of metastatic spread. Management is holistic, with input from members of the multi-disciplinary team (MDT) and centred around the individual patient’s thoughts and wishes. Breast cancer can occur in anyone. It can affect women, trans-women, trans-men, men and non-binary individuals. In men, it is less common and is not within the top 20 cancers affecting

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#Joint diseases and problems #Rheumatology

Amyloidosis

By Dr. Ahmed Hafez

Overview Amyloidosis refers to the extracellular deposition of fibrils that contain a variety of proteins. An amyloid fibril is simply the assembly of insoluble protein fibres that are composed in a way that is resistant to degradation. This composition is known as a beta-pleated sheet. These deposits of amyloid fibrils are extracellular (i.e. occurring outside of cells) and may be seen in different tissues and organs. Hepatic amyloid. Seen as amorphous, acellular pink material on H&E stain The problem with amyloid is that deposition in tissue can lead to organ dysfunction. When organ dysfunction is caused by amyloid we usually

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