Actinomycosis

- indolent, slowly progressive infection caused by anaerobic or microaerophilic bacteria
- most commonly caused by A.israelii
- in vivo growth of actinomycetes usually results in the formation of characteristic clumps called grains or sulfur granules
- occurs most frequently at an oral, cervical or facial site as soft tissue swelling, abscess or mass lesion that is often mistaken for a neoplasm
- abdominal and pelvic actinomycosis usually follows introduction of organism through surgery or IUCD
- thoracic actinomycosis usually follows an indolent progressive course with involvement of pulmonary parenchyma and/or pleural space
- treatment: high dose IV benzylpenicillin and surgical resection/drainage

Cheiroarthropathy

- condition of limited joint mobility that occur in diabetics
- characterised by thickening of skin resulting in contracture of fingers
- unable to extend the fingers to fully flatten the hand
- treatment: pain relieve, phystiotherapy, tight glycemic control

familial hypercholesterolemia

- type IIA hyperlipidemia
- autosomal codominant disorder characterised by elevated plasma levels of LDL-C with normal triglyceride, tendon xanthomas and premature coronary atherosclerosis
- homozygous FH occurs in approximately 1 in 1 million persons worldwide, whereas heterozygous FH occurs in 1 in 500 persons
- most homozygous FH present in childhood with cutaneous xanthomas on hand, wrist, elbows, knees, heels, or buttocks. Total cholesterol levels are usually >500mg/dL and devastating complication of homozygous FH is accelerated atherosclerosis
- treatment for FH is LDL apheresis (homozygous) and statin in combination with cholesterol absorption inhibitor
- family history is usually positive for premature atherosclerotic cardiovascular disease

Erythema gyratum repens

- characteristic concentric erythematous bands forming a wood-grain appearance
- associated with malignancy in up to 80% of patients
- most develop the eruption before the symptoms of malignancy

POEMS syndrome

- rare multisystem disease that occurs in the setting of plasma cell dyscrasia

- P - polyneuropathy (symmetrical and distal)

  O - organomegaly (liver, spleen and lymph nodes)

  E - endocrinopathy

  M - monoclonal gammopathy

  S - skin abnormalities (hyperpigmentation and hypertrichosis)

T-score interpretation

Ann Arbor staging

Warfarin reversal guideline

Warfarin reversal: consensus guidelines, on behalf of the Australasian Society of Thrombosis and Haemostasis. MJA 2004

CURB-65 scoring

Ethylene glycol poisoning

- commonly used as a coolant and preservative and is found in polishes and detergents

- ethylene glycol poisoning often exhibits three distinct clinical phases after ingestion due to toxic metabolites glycolate, glyoxalate and oxalate

- first 12 hours - CNS effect predominate, patient appears intoxicated

- 12-24 hours - cardiopulmonary effect predominate, tachycardia, tachypnea and raised BP are common

- 24-72 hours - renal effects predominate

- hypocalcemia may result from precipitation of calcium oxalate in tissues and may be severe enough to cause tetany and typical ECG changes

- high anion gap metabolic acidosis

- treatment: gastric lavage within 1 hour of ingestion

- inhibit metabolism with intravenous ethanol (competitive inhibitor of alcohol dehydrogenase). Ethanol requires treatment on the ITU because of risk of respiratory depression

- fomepizole is an alternative treatment, being more potent than ethanol but generally more expensive