This is a book written by 3 Family Doctors (GPs) working in the UK giving a structured approach to a touch over 40 cases for te MRCGP exam. The structured approach is useful for both the UK new MRCGP exam and the structured OSCES in the international MRCGP.
You can buy the book via Amazon or perhaps a friend has a second hand copy once the have successfully done the MRCGP.
To give you an idea I have attached an extract of the book under the ‘Fair Dealing‘ section of the UK copyright law. You can download the extracts from below.
Centrally acting. Not unpopular in KSA. Works. Dose: Start 0.2 mg qd (Max 0.4 mg qd). Don’t combine with HTZ, arrythmias, eGFR <60. MOXCON trial : inc mortality in Heart failure given Moxonidine. Does improve insulin resistance but not by much (-0.2 mmol/l).
Package insert. Agonist of imidazoline receptor subtype 1 (I1) found in medulla oblangata. Compared to the older central-acting antihypertensives, moxonidine binds with much greater affinity to the imidazoline I1-receptor than to the α2-receptor. In contrast, clonidine binds to both receptors with equal affinity.
Do not use the above information to self treat! These are meant as a place for me to jot my obervations and notes down rather than on scraps of paper all over the place. If you feel ou may benefit seek the help of a doctor and discuss any ideas you have with him/her.
|25-03-2010||COX2:1 ratios: old table listing these ratios and a diagram on how they work|
|25-03-2010||HT & CVA – U shaped poor outcomes with acute Rx of BP if <160 or >220|
Take home message: Don’t reflexly treat raised BP acutely in CVA.
Just when I thought life was simple, I am starting to understand that HbA1c is not quite what it is meant to be.
First of all it is a dying breed and will be replaced by a new number which is no longer a percentage (Ref):
And why are they doing this?
Because now we are using a more accurate measure of glycosylation of Hb by looking at a single Valine on of the Hb chains rather than using a biological assay which included glycosylation of other things as well as Hb (but UKPDS used this ‘biological’ test! – So is validity true?)
And then I started spotting HbA1c and FG & 2HPP discrepancies:
So I needed to add a bit more to my HbA1c rudimentary knowledge: turns out the 120 day is not quite an accurate picture. The previous 30 days has a 50% impact on the HbA1c while the days 90-120 (before the test) only have a 10-20% effect on it. (http://www.endocrinetoday.com/view.aspx?rid=61106) . So the fresher your RBCs are and the worse your recent sugars are the higher your HbA1c will be even though the MPG (Mean Plasma Glucose) may be unchanged. (MPGs can be worked out by 7 measurements per day – super snazzy glucose meters that sample your glucose automatically).
So does the average life cycle of a red blood cell differ by ethnicity / genetic profile? From the anecdotal lack of complications in my diabetics with HbA1cs off the Richter scale (10-15%) the answer sees to be yes – at least in Saudi Arabia.
Does BTS (Beta Thallasemia Trait) have an effect? Potentially depending on the assay it seems is a possibility. (Ref)
Vitamin B12: Yes – no – yes again? Should we be checking Vitamin B12 once a year? Read this case report which argues for a yes: Report of Metformin induced B12 deficiency and neuropathy.
And then finally to cap it all off – statins can increase your risk of diabetes by 9%! This is the result of a meta-analysis published in the Lancet in Feb 2010. (Read more here). In short if you are low risk then it may not be a good idea, for moderate to high risk and if your old it works out as follows:
Results further revealed that treatment of 255 patients with statins for four years would result in one extra case of diabetes. But, for 1 mmol/L reduction in LDL concentration, the same 255 patients could expect to experience five fewer major coronary events, such as coronary heart disease death or nonfatal myocardial infarction.
Hope you are good at statistics and risk analysis and perhaps a bit of Bayes theorem.
Came across an interesting book while passing through Dubai duty free called Buyology by a Martin Lindstorm. I thought it had some interesting messages for us as Family Physicians when dealing with our patients who are also customers and recipients of very powerful advertising messages that are not always in their best health interests. I had a chance to present the material to our team of doctors at the Family Medicine Department in King Faisal Hospital, Jeddah.
One of the most interesting and alarming findings was that health advice on cigarette adverts actually increase the desire of smokers to have a cigarette!
You can download the presentation here: Buy.ology.
All copyrighted images belong to the orignal sources (via Google Images)
Possible congenital heart defects according to the MHRA.