Monthly Archives: August 2018

Apixaban interactions

Letter through from the pharmacy company regarding apixaban; apparently it interacts with SSRIs/SNRIs, which potentiate its action. So use with caution. Clarithromycin does not potentiate its action, although the letter didn’t specify whether QT prolongation would be a potential issue. … Continue reading

Posted in Anticoagulants, Credits 2018, Medication | Leave a comment

Hip pain in young adults

Like everyone else in medical school, I learned the likely differential diagnoses of hip pain with age; various causes for the various stages of childhood, then osteoarthritis for older people. There is, of course, a big gap there for young … Continue reading

Posted in Credits 2018, Orthopaedics | Leave a comment

Rheumatoid arthritis

Quick update on a couple of relevant NICE guidance points, from the BMJ: Refer any adult with persistent suspected synovitis of unknown cause. The referral should be urgent if: small joints of hands or feet are affected >1 joint is … Continue reading

Posted in Credits 2018, Rheumatoid arthritis, Rheumatology | Leave a comment

Bradycardia

1st degree AV  block Not necessarily a problem; can be due to: normal aging physiological differences (the normal range is based on the middle 95% of the population, so some people are going to fall outside it) high vagal tone … Continue reading

Posted in Cardiovascular | Leave a comment

Ectopic beats

Atrial ectopics: common, not usually of clinical significance although occasionally trigger AF. Worsened by age, caffeine, alcohol, beta-agonists, levothyroxine, and conditions such as CCF or mitral valve disease that cause atrial stretching/enlargement. Ventricular ectopics: common, don’t seem to be harmful … Continue reading

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Orofacial pain

This often gets inaccurately attributed to rhinosinusitis; in fact, chronic rhinosinusitis does not cause orofacial pain (although acute episodes can do so). Consider the presence or absence of nasal symptoms (blockage/congestion, +/- nasal discharge) and of tenderness or swelling of … Continue reading

Posted in Credits 2018, ENT | Leave a comment

Idiopathic pulmonary fibrosis

Quick refresher in May’s BJGP: Interstitial lung disease, characterised by progressive scarring of the lungs Typically presents in 6th or 7th decade Presents with persistent progressive breathlessness, with or without cough Signs include finger clubbing and velcro crackles – not … Continue reading

Posted in Credits 2018, Respiratory | Leave a comment