SA Medical - General Medicine And Imaging of Disease

Dizziness refers to an impairment in spatial perception and stability. Dizziness is considered imprecise.Dizziness can be used to mean vertigo, presyncope, disequilibrium, or for a non-specific feeling such as giddiness or foolishness. Vertigo is a specific medical term used to describe the sensation of spinning or having one's surroundings spin about them. Many people find vertigo very disturbing and often report associated nausea and vomiting. It represents about 25% of cases of occurrences of dizziness. Disequilibrium is the sensation of being off balance, and is most often characterized by frequent falls in a specific direction. This condition is not often associated with nausea or vomiting. Presyncope is lightheadedness, muscular weakness and feeling faint as opposed to a syncope, which is actually fainting. Non-specific dizziness is often psychiatric in origin. It is a diagnosis of exclusion and can sometimes be brought about by hyperventilation. A stroke is the

Dear patients Thank you for your most interesting questions and thank you for trusting me to manage you health. This is an interesting question. To answer these question we need to talk about Calcium, phosphate and magnesium in the Human Body. Calcium content of the body depends on the balance between the intestinal calcium from diet and the calcium lost in your faeces (shit) and urine (pee). Intestinal (GUT) uptake and loss The amount of calcium that is absorbed is dependent on Amount of calcium (Ca2+) available.  Acid pH increases calcium and alkalinity promotes complex formation and diminishes absorption.  The following reduce your calcium absorption: Uncooked beans - phytates and Oxalytes - chocolate, nuts and berries - and tea Active Vitamin D Kidney The kidney filters 250mmol of Calcium each day, 95% are reabsorbed in the tubules. The majority is taken up in the proximal tubules without hormonal regulation, while fine adjustment is required to the amoun

Dear patients Thank you for your most interesting questions and thank you for trusting me to manage you health. Breathlessness Dyspnoea is the perception of breathlessness and may be exertional or, when more advanced, occur at rest. It may only occur when lying down (orthopnoea). Is the breathlessness a recent development? Is it episodic? Ask how far the patient can walk without stopping (often an unreliable history) and how many pillows he/she uses in bed at night (in orthopnoea). Look for digital clubbing, central cyanosis and chest wall deformities. Pulmonary causes Pneumonia, e.g. bacterial, viral. Bronchitis—acute or chronic. COPD. Acute asthma. Pneumothorax—even a small pneumothorax may acutely exacerbate dyspnoea in patients with pre-existing chronic pulmonary disease. Interstitial lung disease—e.g. sarcoidosis, fibrosing alveolitis, extrinsic allergic alveolitis, pneumoconiosis. Bronchogenic carcinoma. Foreign body obstructing bronchus (esp. children—peanut in rig

Dear patients Thank you for your most interesting questions and thank you for trusting me to manage you health. If the heart rate is <60 beats/min, the patient, by definition, has a bradycardia (an arbitrary definition). Bradycardia may be transient, chronic or intermittent. A slow pulse can be physiological (in trained athletes) but may also be indicative of potentially serious cardiac disease. Bradycardia may result from  Increased vagal tone.  Decreased sympathetic drive.  Cardiac drug therapy is a prominent cause, e.g. – -adrenergic blockers (Note: -blocker eye drops (used in treatment of glaucoma) may be systemically absorbed causing bradycardia). – Digoxin (AV block). – Diltiazem. – Verapamil. – Amiodarone (Note: may also cause iatrogenic hypothyroidism). iInjudicous combinations of these drugs may lead to serious bradycardia or heart block. Consider self-accidental or deliberate self-poisoning (includes opiates). Other causes During normal phases of slee

Ataxia Ataxia is an impaired ability to coordinate limb movements. There must be no motor paresis (e.g. monoparesis) or involuntary movements (e.g. the characteristic cog-wheel tremor in Parkinson’s disease is not ataxia). Ataxia may be:  Cerebellar.  Vestibular.  Sensory. Note: Many forms of ataxia are hereditary (but are uncommon). Hereditary causes  Friedreich’s ataxia.  Ataxia telangiectasia.  Spinocerebellar ataxia.  Corticocerebellar atrophy.  Olivopontocerebellar atrophy.  Hereditary spastic paraplegia.  Xeroderma pigmentosa. Investigations 2 Family studies. Genetic analysis (discuss with regional genetics laboratory—counselling may be required). Vestibular ataxia Acute alcohol intoxication.  Labyrinthitis. Sensory ataxia  Loss of proprioception—peripheral neuropathy, dorsal column disease.  Visual disturbance. Investigations  Venous plasma glucose (diabetic neuropathy).  Serum vitamin B12 (subacute combined degeneration of the cord—rare, but ser

Dear patients Thank you for your most interesting questions and thank you for trusting me to manage you health. Anuria denotes absent urine production. Oliguria (<400mL urine/24h) is more common than anuria. A catheter must be passed to confirm an empty bladder. Causes Urinary retention —prostatic hypertrophy, pelvic mass, drugs, e.g. tricyclic antidepressants, spinal cord lesions. Blocked indwelling urinary catheter. Obstruction of the ureters —tumour, stone, sloughed papillae (bilateral). Intrinsic renal failure —acute glomerulonephritis, acute interstitial nephritis, acute tubular necrosis, rhabdomyolysis. Pre-renal failure —dehydration, septic shock, cardiogenic shock. An urgent ultrasound of the renal tract must be performed and any physical obstruction relieved as quickly as possible, directly (urethral catheter) or indirectly (nephrostomy). Renal function and serum electrolytes must be measured without delay. Further tests as clinically indicated  FBC.  

Causes of bilateral ankle oedema  Right ventricular failure—2° to chronic lung disease.  Congestive cardiac failure (CCF)—cardiomyopathy, constrictive pericarditis, etc.  Hypoalbuminaemia—nephrotic syndrome, hepatic cirrhosis, proteinlosing enteropathy, malnutrition (starvation or malabsorption), (gravity).  Dependent oedema (immobility).  Drugs—Ca2+ channel blockers, NSAIDS.  Idiopathic/cyclical oedema syndrome.  Pregnancy.  Wet beriberi (rare in Western societies but commoner in Africa). Essential investigations  U&E.  LFTS.  Urine dipstick for proteinuria.  Urine protein/creatinine ratio or 24h urine protein excretion.  CXR.  12-lead ECG.  Echocardiogram. Consider  Liver USS.  Doppler studies of leg veins.  Contrast venography.  Filariasis serology/blood film.  Xylose breath test.  OGD with small bowel biopsy. All the causes of unilateral ankle oedema may also cause bilateral oedema.

Clinical Features: Rapid onset (hours to days) fever, chills, nausea, vomiting, myalgia, malaise costovertabral angle CVA tenderness or exquisite flank pain LUTS (Urgency, frequency, dysuria) may have symptoms of GN sepsis atypical presentation in the elderly: confusion may be the only symptom Investigations: Urine dipsticks: +ve leucocytes and nitrates, possible hematuria U-MCS: Microscopy: >5WCC per HPF in unspun urine or > 10 WCC/HPF in spun urine Gram stain: GN bacilli, GP cocci u-CS - Culture and sensitivity:  >10^6 colony forming units (CFU)/ml in clean catch MSU or >10^2 CFU/ml in suprapubic aspirate or catheterised specimen Bloods:  CBC + differential: Increase WCC (leucocytosis), Increase neutrophils, left-shift Blood cultures only positive in 20% of cases  Consider investigation for pyelonephritis if: fever, pain, leucocytosis not resoving with treatment in 72 hours male patient history of urinary tract abnormalities CT for renal abcess, spira