Monthly Archives: December 2012


Ovestin vaginal cream does not increase circulating oestradiol, and thus can be considered for treatment of vaginal dryness in women who’ve had breast cancer. Evidence varies on whether systemic oestrogen increases recurrence risk (HABIT trial vs. Stockholm trial) but it’s … Continue reading

Posted in BJGP, Cardiovascular, HRT, Hypertension, Medication | 1 Comment

Palliative care

Batting order of anti-emetics: Metoclopramide Haloperidol Levomepromazine Oxycodone may cause fewer central SEs than morphine. Different patients can have different levels of response to morphine & oxycodone. For breakthrough pain, use buccal, sublingual, or intranasal medication – oral takes too … Continue reading

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ASAS criteria for inflammatory back pain

Present for >3 months, plus at least 4 of the following: Onset <40 years of age Insidious onset Improves with exercise No improvement with rest Night pain which improves on getting up Types of inflammatory back pain are: Anklylosing spondylitis … Continue reading

Posted in Rheumatology | Leave a comment

Ankle sprains – rehabilitation in a footballer

Useful guidelines in Arthritis Research UK (Summer 2012) – the idea is first to return the injured body part to full strength and function, then work through a graduated return-to-play strategy. Suggestions: Initially – Review re. need for X-ray as … Continue reading

Posted in Credits 2012, Ligaments, Orthopaedics | Leave a comment


It’s now debatable whether we should give antibiotics for uncomplicated diverticulitis. While there isn’t sufficient evidence to say definitively that we shouldn’t, there are now a few trials showing that they don’t do anything, which certainly gives cause to question … Continue reading

Posted in Credits 2012, Diabetes, Endocrinology, Gastroenterology, Pain control | Leave a comment


Most common causes of 2ry osteoporosis are coeliac disease and primary hyperparathyroidism; myeloma is also a cause. Therefore, investigations include FBC, PV, U&Es, coeliac screen, calcium profile, and immunuglobulins, possibly plus BJP. What the pick-up rate and cost-effectiveness of these … Continue reading

Posted in Credits 2012, Osteoporosis | Leave a comment

Resistant hypertension

Defined as BP above target despite 3 antihypertensives at best tolerated doses. However, before diagnosing it, check that that actually is what’s happening: Are the drugs being taken as prescribed? Compliance issues, comprehension issues, memory. Is BP measurement correct? Poor … Continue reading

Posted in Cardiovascular, Hypertension | Leave a comment