Category Archives: Credits 2018

High-dose B12 therapy

The standard maintenance course of injectable B12 (after the two week loading period) is 1 mg every three months. Occasionally, I’ve come across a patient who finds that the effects of the injection wear off, and the symptoms of deficiency … Continue reading

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

Thyrotoxicosis – initial treatment

An article from the BMJ, with some useful tips on starting anti-thyroid drugs if necessary. Causes: Medication-related (see below) Thyroiditis (subacute, de Quervain’s, initial phase Hashimoto’s, postpartum) Grave’s Toxic multinodular goitre Solitary toxic adenoma Very rarely, functional thyroid carcinoma Medication-related … Continue reading

Posted in Credits 2018, Endocrinology, Thyroid | Leave a comment

Scarlet fever

Pathology S. pyogenes (also known as Group A streptococcus) is usually an unproblematic commensal in the skin or on the throat, but some forms produce superantigens including pyrogenic exotoxins; these can cause non-invasive infections such as scarlet fever. Presentation Initially … Continue reading

Posted in Credits 2018, Infectious Diseases | Leave a comment

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.

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

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