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Medicine Flashcards

1
Q

Focal seizure

A

Focal onset, behaviour

LOC + → FS with impaired awareness - automatisms, longer duration (>30s)
LOC - → FS with intact awarness

Lamotrigene - preferred
Leviteracetam - elderly

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2
Q

Absence seizure

A

LOC +, Tone ⓝ
EEG - spike and waves (domes)
DOC - Ethosuximide

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3
Q

JME

A

Juvenile
Family h/o
Many seizures
- (mc) myoclonus ↑ on awakening
- GTCS
- Absence seizure

DOC - valproate
Fertile female - Leviteracetam

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4
Q

GTCS

A

3 stages
Tonic - stiff - ictal cry +
Clonic - froathing
Post ictal - flaccid

DOC - Valproate

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5
Q

Temporal lobe epilepsy

A

Febrile seizure + Focal seizure+ LOC

Temporal lesion - Hippocampal sclerosis

TOC - Surgery

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6
Q

Status epilecticus

A

Seizure> 5mins

DOC Lorazepam
Late - refractory - Thiopentone

Carbamazepine not recommended

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7
Q

Seizure in pregnancy

A

Seizure frequency ↑30%
Already on AED, continue on lowest effective monotherapy dose

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8
Q

Movement disorders

A

Athetosis - crawling - globus pallidous
Chorea - dance - caudate nucleus
Ballismus - flinging - C/L Sub thalamic nucleus

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9
Q

Tremors

A

Intentional - cerebellar
Flapping - Encephalopathy
Fine - Thyrotoxicosis
Essential - AD - ↑ in anxiety - ↓ in drinking - DOC - propranolol

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10
Q

Rigidity

A

Cog wheel - Parkinsons
Lead pipe - Extra pyramidal
Clasp knife - Pyramidal

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11
Q

Parkinsonism

A

mc - Idiopathic - Parkinson’s disease
Mcc of 2° Iatrogenic
Inherited - AD - LRRK gene - chr 12

C/F
°Resting Tremors
°Cog wheel rigidity
°Bradykinesia

°Micrographia
°Monotonous speech
°Mask like face
°Non motor
-Anosmia (1st symptom)
-Depression++
-Dementia

T/t - DOC - Levodopa
<60 yrs - Dopamine agonist
Neuroprotective - Rasagiline
Rescue therapy - Apomorphine

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12
Q

Progressive supra nuclear palsy

A

Extended posture
Defective down gaze - surprised look - forehead wrinkles - early falls
Vertical square wave jerks in eyes
Dystonia

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13
Q

Dementia of lewy body

A

Parkinson
Early onset dementia
Visual hallucinations

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14
Q

ACA infarction

A

LL weakness + Urinary incontinence - Paracentral lobule
Primitive reflexes - supplementary motor area
Antisocial behaviour
Gait apraxia
Abulia - cingulate gyrus - loss of motivation

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15
Q

Left MCA infarction

A

Aphasia
- proximal M1 - Global
- superior division - Broca’s
- Inferior division - wernicke’s

Gerstman syndrome - Angular gyrus
- acalculia - impaired calculation
- finger agnosia
- left right disorientation
- agraphia - cannot write

Right hemiparesis and hemianesthesia

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16
Q

Right MCA syndrome

A

Right angular gyrus

Hemispatial neglect
Aphasia (-)
Left hemiparesis and hemianesthesia

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17
Q

PCA infarction

A

Cortical blindness with macular sparing
Amnesia
Alexia - cannot read

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18
Q

Dejerine Roussy Syndrome

A

Anesthesia
Paraesthesia - altered sensation
Lateral thalamus lesion

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19
Q

Antons syndrome

A

Partal blindness
Unaware
Palinopsia - moving objects as multiple images

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20
Q

Balint’s syndrome

A

Occulomotor apraxia
Optic ataxia
Simultagnosia

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21
Q

Visual spatial orientation

A

Hand eye coordination
Parietal lobe

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22
Q

Complete hemiparesis

A

Cortical lesion
MCA infarct
Weakness - ↑↑UL, ↑LL, (+)Face

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23
Q

Dense hemiparesis / pure motor hemiparesis

A

Internal capsule lesion
MCA infarct
Weakness UL = LL
Face - spared

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24
Q

Acute ischemic stroke treatment

A

rtpa - iv - 0.9 mg/kg - <4.5 hrs
Aspirin
Anticoagulants - AF, Prosthetic valves

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25
Q

Indications of thrombolysis

A

I/V < 4.5 hrs
Large vessel occlusion <6hrs
Large deficit after iv thrombolysis- intra arterial thrombectomy <24 hrs

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26
Q

C/I for thrombolysis

A

BP >185/110 mmhg
Bleeding diasthesis
Hemorrhagic cva

Major surgery <14 days
GI bleed <21 days

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27
Q

Intracerebral hemorrhage

A

Mc hypertension - mc putamen - C/L hemiparesis
Thalamus - hemianesthesia
Cerebellum - Ataxia, Vertigo
Pons - pinpoint pupil, quadriparesis, ↑HR, ↑RR, ↑thermia, ↑hidrosis, deep coma, B/L plantar extensor

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28
Q

Subarachnoid hemorrhage

A

Mcc - trauma
Mcc spontaneous - berry aneurysm - defect in tunica media
AVM

C/f
Thunderclap headache
Neck rigidity with ↓ flexion
LOC

Re rupture - mcc mortality
Vasospasm - mcc morbidity
Hydrocephalus

Investigation
SAH - NCCT
Aneurysm - Angiography
Xanthochromia in CSF

Treatment
Surgery - coiling, clipping
Nimodipine - (-)Vasospasm
Maintain HTN, Hypervolemia, Hemodilution

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29
Q

Berry aneurysm

A

Mc site: ACA - Acom junction
Mc site of rupture: Basilar bifurcation

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30
Q

SDH

A

Rupture of cortical bridging veins
Slow progressing deficit
CT - concavoconvex opacity

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31
Q

EDH

A

Rupture of MMA
Fast progressing deficit
Lucid interval (+)
CT - Biconvex opacity

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32
Q

Myasthenia Gravis

A

Mc ocular > facial(snarling) > skeletal(proximal)
DTR(n)

Investigation
Screening test: Ice pack test
Specific test: AchR Antibodies
Sensitive test: Single fibre EMG → ↑Jitter

Treatment
Ach inhibitors - pyridostigmine
Immunosuppression: M.crisis - IVIG/Plasmapharesis
Thymectomy

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33
Q

Lamberton eaton myasthenic syndrome

A

Mc ass. Small Cell Ca lung
Defect: presynaptic ca2+ channel
Weakness: skeletal
DTR (-)

Treatment: 3,4 DiAmini Pyridine

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34
Q

Alzheimer’s diseases

A

Amyloidosis:
APP(precursor)(chr21)→Aβ42 (enzyme secretase: chr 1, 14)
ApoE4(chr19) →(-) excretion
Atrophy - temporal & parietal
Ammesia

Neurofibrillary tangles α severity
Senile plaques α Age
Tau - neurodegeneration marker

Anterograde amnesia
Anomic aphasia
Apraxia

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35
Q

Fronto Temporal Dementia

A

Capgras syndrome
Amnesia
Tau proteins

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36
Q

Normal pressure hydrocephalus

A

Hakims triad
Gait ataxia
Urinary incontinence
Dementia

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37
Q

Huntington chorea

A

AD inheritance
Chorea
Dementia
Box car ventricles

Treatment: Tetrabenazine (DA depletor)

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38
Q

Wernicke’s encephalopathy

A

Global confusion
Ophthalmopathy (1st to improve)
Ataxia

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39
Q

Creutzfeld jackob disease

A

Mc - Startle myoclonus
Spongiform degeneration
Cortical ribboning

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40
Q

Pseudotumor cerebri

A

Young obese female
Headache
↑ICT
Papilledema
No FND

Mc - Idiopathic
Iatrogenic - ↑Vit.A
↓CSF absorption

Treatment
Acetazolamide

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41
Q

Tension headache

A

Dull aching
Depression
DOC: TCA

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42
Q

Migraine

A

Pulsatile
U/L
Nausea(+)

Aura (+) - classical
Aura (-) - common

Treatment
Triptans (doc)
Nsaids
CGRP(-) - gepants

> 4 attacks in a month - Prophylaxis
β blockers
CCB
TCA

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43
Q

Cluster headache

A

Clustered attacks
Periorbital pain
Lacrimation

Treatment
O2 @ 10-12L/min x 10 - 15 mins
Sumatriptan 6mg s/c
Prophylaxis - verapamil

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44
Q

Pyogenic menigitis

A

Mcc in adolescent & epidemics - N. Meningitidis
Mcc in adults/elderly & CAM - S. Pneumoniae
Neonates & elderly - Listeria

Kernigs sign
Brudzinki sign
Fever
Headache
Neck rigidity

CSF - Turbid, ↑cell count(N>L), ↑proteins, ↓↓glucose

Treatment
Dexa and antibiotics

Fever

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45
Q

Tubercular meningitis

A

Basal exudates
Tuberculoma
Infarct

CSF: cobweb appearance, cell count (L>N), ↑↑proteins, ↓glucose

Treatment
ATT x 12-18 months
Steroids x 2 months

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46
Q

HSV encephalitis

A

Fever
Altered sensorium
Seizure

CSF: Xanthochromic,cell count(L>N), ↑protein, glucose(n)

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47
Q

Neurocysticercosis

A

Agent - Taenia solium
Human - definitive host
Pig - intermediate host

Seizure
Headache
Hydrocephalus

Stages
Vesicular
Colloid - edema+++
Calcified - edema(-)

Treatment
Steroids→Albendazole
Anti epileptics

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48
Q

Guillian barre syndrome

A

Acute Inflammatory demyelinating polyneuropathy
IgG Anti GM1 a/b - schwann cells - demyelination
Post infectious - C.jejuni

Ascending paralysis
Areflexia
Absent fever

Other forms:
AMAN(children), AMSAN(Adults) - IgG Anti GM1 a/b - Nodes of Ranvier - Axonal degeneration

(Severe form) Miller Fisher Syndrome - Ataxia, Areflexia, Ophthalmoplegia - Anti GQ1 antibody - demyelination/axonal degeneration

Investigation:
Nerve conduction - loss of F wave
CSF - ↑Albumin, cell count(n)

Treatment
IVIG/Plasmapharesis within 14 days
Steroids not used

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49
Q

Multiple sclerosis

A

U/L optic neuritis
Weakness
Sensory symptoms

Types
Relapsing MS 90%
Primary progressive MS 10%
Secondary progressive MS 2%

Investigation:
MRI: Dawson fingers
CSF: ↑IgG levels, oligoclonal bands
VEP: ↑latenct

Treatment:
Steroids - Acute attack
IFN β - DOC
Natalizumab - best - ↓relapses

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50
Q

Neuromyelitis optica

A

B/L optic neuritis
Transverse myelitis
Aquaporin 4 antibodies

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51
Q

Syringomyelia

A

Dissociated anesthesia - capeflag distribution
Cuts spinothalamic
Spares posterior column

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52
Q

Conus medullaris syndrome

A

Saddle anesthesia
Knee jerk++
Autonomous Bladder

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53
Q

Cauda equina syndrome

A

Areflexia(+)
Asymmetrical LMN paralysis

54
Q

Friedrich ataxia

A

GAA
Ataxia
Areflexia
Extensor plantar
Pes cavus - high arched foot
Scoliosis
↓Vit E

55
Q

Tabes dorsalis

A

Ataxia
Areflexia
Neurosyphilis

56
Q

SACD

A

Ataxia
Areflexia
↓vit b12
Glossitis
Peripheral neuritis

57
Q

Amyotropic lateral sclerosis

A

Weakness
Bladder (n)
Fasciculations

58
Q

Fasciculations seen in

A

ALS
SMA
Polio

59
Q

Weber syndrome

A

Medial midbrain - PCA
III CN - I/L gaze palsy
CS - C/L hemiparesis

60
Q

Claude syndrome

A

Medial midbrain - PCA
III CN - I/L gaze palsy
Red nucleus - dysdiadochokinesia

61
Q

Benedict syndrome

A

Medial midbrain - PCA
Weber + claude
III CN - I/L gaze palsy
CS - C/L hemiparesis
Red nucleus - dysdiadochokinesia

62
Q

Nothnegal syndrome

A

Lateral midbrain - PCA
III CN - I/L gaze palsy
SCP - C/L cerebellar ataxia

63
Q

Millard gubler syndrome

A

Medial pons - Basillar A.
VI CN diplopia, lateral gaze palsy
VII CN facial weakness
CS C/L limb weakness

64
Q

Fovielle syndrome

A

Inferior Medial pons - Basillar A.
VI CN - diplopia, lateral gaze palsy
VII CN - facial weakness
CS - C/L limb weakness
Medial lemniscus - proprioception and vibration
MLF - IPSILATERAL: ataxia

65
Q

Marie fox syndrome

A

Lateral pons - AICA
SL - CONTRALATERAL: limb weakness, limb pain and temperature
MCP - IPSILATERAL: limb ataxia, facial paralysis, hearing loss, vertigo and nystagmus

66
Q

Dejerine syndrome

A

Medial medullary syndrome - ACA
XII - I/L tongue weakness/atrophy
ML - C/L vibration and proprioception loss
CS - C/L limb weakness

67
Q

Wallenberg syndrome

A

Lateral medullary syndrome - Vertebral>PICA
V CN - I/L face pain and temperature
VIII CN - vertigo, nystagmus
IX, X CN - Nuclues ambiguous - hoarseness, dysphagia, gag reflex
SL - C/L pain and temperature
ICP - I/L ataxia, past pointing
Sympathetic trunk - I/L horner’s syndrome

68
Q

raymond syndrome

A

IPSILATERAL: lateral gaze weakness (VI)
CONTRALATERAL: limb weakness (CS)

69
Q

Hyperprolactinemia

A

Causes
Physiological - pregnancy
Drugs - DA(-) & DA depletors
Atypical antipsychotic - Resperidone
Prolactinoma

C/F
Galactorrhea
Amenorrhea
Infertility
Bitemporal hemianopia

Treatment
MRI
DOC - cabergoline
Pregnancy - bromocriptine
Surgery - Transsphenoidal resection

70
Q

Acromegaly

A

Prognathism
Spade like digits
Jaw malocclusion
CVS - LVH, CAD
RS - OSA
Endocrine - DM, Goitre

Mcc death: MI

Investigation:
Screening: S. IGF 1 levels
Confirmatory: GH suppression test
Etiology: MRI

Treatment
Surgery: Transsphenoidal resection
Medical:
somatostatins - octreotide, lanreotide
GH(-) - Pegvisomant
Radiotherapy

71
Q

Diabetes insipidus

A

↓urine osmolality
↑serum osmolality
↑serum sodium

Central DI
ADH deficiency
Bright spot(-)
T/t: Desmopressin

Nephrogenic DI
ADH resistance
ADH stimulation test
T/t: thiazide

72
Q

SIADH

A

↑urine osmolality
↓serum osmolality
↓serum sodium
Euvolemia - Vasopressin escape - down regulation of Aquaporin 2 channels

73
Q

Cushings syndrome

A

Mcc Iatrogenic
Mcc endogenous - pituitary adenoma
Mcc ectopic - SCC of Lung

C/F
↑protein breakdown, striae, thin skin, fat redistribution (buffalo hump), hypernatremia,
hypokalemic alkalosis - ectopic ACTH

Investigation
Screening - oral dexa challenge test
Confirmatory - Low dose dexa test
Etiology - high dose dexa test

Treatment
ACTH(-) - somatostatins
Cortisol(-) - Mifepristone
↓cortisol - metyrapone, ketoconazole

74
Q

Hyperaldosteronism

A

Mcc - adrenal hyperplasia
Mcc conns - adrenal adenoma

C/F
Diastolic HTN
Hypokalemic alkalosis

Investigation
Screening test - Aldosterone renin ratio
Confirmatory - Saline infusion test
Etiology - CT Abdomen

Treatment
Spironolactone
Surgery

75
Q

Adrenal insufficiency

A

Addisons
Mcc - autoimmune
Mcc in India - TB
Pituitary

C/F
Hypoglycemia
Hyponatremia
Hypotension
Localized hyperpigmentation

Investigation
ACTH stimulation test
Adrenal Ab - Autoimmune
CT Abdomen - TB

Treatment
Suspected addisons - Dexamethasone
Autoimmune - hydrocortisone
TB - ATT

76
Q

Diabetes mellitus

A

Type 1: Insulin deficiency, Age <30 yrs, thin
Type 2: Insulin resistance, Age >30 yrs, obese

C/F
Triad
Polyuria
Polydipsia
Wt. Loss

Diagnosis
RBS >200mg/dL + symptoms
FBS >126mg/dL
OGTT > 200mg/dL
HbA1C >6.5%

77
Q

MODY

A

Mature onset of diabetes in young
↓insulin secretion
5-15 yrs
OHA responsive - sulfonyl ureas
Thin

78
Q

DKA

A

RBS 250-600 mg/dL
↓pH
Ketone bodies (+)

C/F
Vomiting
Tachypnea
Dehydration

Treatment
FLIP
Fluids - NS
Insulin - regular
Potassium

79
Q

Hyperosmolar coma

A

RBS 600-1000 mg/dL
↑S. Osmolality
Altered sensorium

80
Q

Diabetic neuropathy

A

polyneuropathy - Mc - symmetrical sensory - glove and stocking - t/t pregabalin
Mononeuropathy - mc - III CN - pupil sparing
Autonomic neuropathy - hypoglycemic unawareness

81
Q

Whipples triad

A

Hypoglycemia <50 mg/dL
Sweating, dizziness
Reversal of symptoms on correction

82
Q

Hypothyroidism

A

↑TSH, ↓FT3, ↓FT4

Myxedema - ↑GAGs in skin, traps H2O, non pitting edema
Alopecia (↓hair follicle stimulation)
↓nail growth

Bradycardia
Diastolic hypertension
Cold intolerance

Fatigue
Weight gain
Constipation

Treatment
L Thyroxine 1.6 μg/kg/day (lower dose in CAD & elderly)
TSH after 6 weeks - target (0.55-2.5) - continue - yearly TSH
TSH >2.5 - ↑25μg
Supplements - calcium

83
Q

Hyperthyroidism

A

↓TSH, ↑FT3, ↑FT4

Orange skin
Clubbing
Alopecia ( hair follicles burnout)

Atrial fibrillation
Hypertension
Heat intolerance

Fine tremors
Weight loss
Exophthalmos

Treatment
Carbimazole/Propylthiouracil
Propranolol
Radioiodine

84
Q

Hypercalcemia

A

Parathyroid adenoma
RCC
Breast ca
Small cell ca Lung
Hematological malignancy
↑Vit. D

Abdominal pain
Renal calculi
Polyuria

Treatment
IVF + Loop diuretics
Bisphosphonates
Rank ligand inhibitor - denosumab ( most powerful anti resorptive)

85
Q

Tumor lysis syndrome

A

PUKE Calcium
↑PO4
↑Uric acid
↑K+
↓Calcium

86
Q

Barter syndrome

A

Most severe Inherited channelopathy - AR (M>F) inhibitory defect in NaK2CL ATPase
Mc tubular defect causing deafness
Hyperaldosteronemia
Failure to thrive

Na and H2O loss in urine
Hypotension (mc)
Hypokalemic Alkalosis
30% - deafness
IU - polyhydramnios
★Hypercalciuria - nephrocalcinosis
Exclude: loop diuretic use

Treatment
★NSAIDs responsive - elevated pgs
No cure
Worst prognosis

87
Q

Gitelman’s syndrome

A

Milder inherited channelopathy - AR inhibitory defect in NaCl co-transporter
20-30 yrs, M = F

Loss of Na and H2O in urine
Mild dehydration
2° hypomagnesemia: Ileus, Arryhthmia
Exclude: Thiazide use

Treatment
Mg2+ supplementation: reversal and prevention of symptoms
Favourable prognosis

88
Q

Gordon’s syndrome

A

Inherited channelopathy - AD stimulatory defect in NaCl co-transporter
20-30 yrs, M = F

Hyperkalemic metabolic acidosis
Hypertension
S. Aldosterone (n)
Pseudohypoaldosteronism

Treatment
Thiazide responsive: Palliative

89
Q

Liddles syndrome

A

Inherited channelopathy - AD stimulation ENaC (mimics ↑aldo)
20 - 30 yrs M = F

S. Aldosterone undetectable
Pseudohyperaldosteronism
Young onset Hypertension
Hypokalemic metabolic acidosis
Edema
Exclude: steroid use
Incidental diagnosis

Treatment
DOC: Amiloride
Best prognosis

90
Q

Cockroft and gault formula

A

eGFR = (140 - Age) x weight(kgs) / 72 x S.creatinine

91
Q

CKD staging

A

Best formula - CKD EPI formula
Inulin clearance - Ideal for GFR
Preferred: eGFR
Stages
1)90-120ml/min - Asymptomatic
2) 60-89 ml/min
3) 30-59 ml/min
4) 15-29 ml/min
5) <15 ml/min

Treatment
1,2 - Microalbuminuria(30-300mg) and reversible stages:
Control risk factors
Avoid nephrotoxic drugs (nsaids)
Ensure adequate hydration
DOC: ACE inhibitors (to prevent capillary endothelial damage)

3,4,5: Gross albuminuria(>300mg) and irreversible stages:
Erythropoietin
Correct mineral homeostasis
Renal replacement therapy
AV fistula
Hep B vaccination

Diuretics
1,2,3: Loop diuretics
4,5: loop diuretics+ Metalazone

Finrenone - new selective mineralocorticoid receptor antagonist - ↓risk of ↑K+ - in stages 1&2 to prevent progression

92
Q

IgA Nephropathy

A

Berger’s disease
20-30 yrs, M>F

Rec. Gross hematutia <1 week of URTI
Synpharyngitic nephropathy

↑IgA
Complement (n)
IgA predominant Granular deposits

Least risk of RPGN <1%
Best prognosis

93
Q

PSGN

A

Mc in India
School children

Classic nephritis, 1-3 weeks after sore throat

Anti DNAase(mc)
ASO(30%)
IgG predominant Granular deposits

1-5% risk of RPGN
2nd best prognosis

94
Q

Vasculitis syndrome

A

Pulmonary renal syndrome
30-50 yrs, M=F

Hematuria
Hemoptysis
+Any other organ(skin in child - HSP)

ANCA(+)
Pauci immune

30-70% risk of RPGN
2nd worst prognosis

95
Q

Goodpasture syndrome

A

Pulmonary renal syndrome
Anti basement membrane disease
30-50 yrs, M=F

Hematuria
Hemoptysis

α3 subunit of type 4 collagen
Anti GBM(+)
Linear deposits

> 90% risk of RPGN
worst prognosis

96
Q

Post Streptococcus infection

A

URTI - Acute rheumatic fever, PSGN
Skin - only PSGN

97
Q

Alports syndrome

A

α5 subunit of type 4 collagen

Hematuria
Deafness
Lens defect

98
Q

Immunofluorescence patterns in rheumatology

A

Homogeneous - Anti dsDNA/ histone Ab - SLE
Speckled - Anti ro/la, anti jo, anti u1 RNP
Nucleolar - Anti topoisomerase 1 Ab
Centromere - Anti centromere Ab

99
Q

Δ Ab in SLE

A

SLICC criteria

ANA
Anti Smith (most specific - rim pattern)
Anti dsDNA
APLA
DCT
Serum C3

Eular - except DCT other 5

100
Q

Rheumatoid arthritis

A

20-40 yrs, ★F>M
Symmetrical polyarthritis in small joints
Mc ocular - 2° sicca
Mc ILD - UIP
Mc valve defect - MR
Mcc death - HF

Treatment
DMARDs

101
Q

Psoariatic arthropathy

A

20-40 yrs M=F
Symmetrical polyarthritis + DIP joint

85% preceeded by skin and nail changes(oncholysis★ - peeling)

Treatment
NSAIDS

102
Q

IBD associated arthropathy

A

20-40 yrs M=F
Asymmetrical
Shoulder and elbow joint

Mc preceded by diarrhea
Rare/specific skin manifestation - pyoderma gangrenosum

Treatment
NSAIDS

103
Q

IBD associated arthropathy

A

20-40 yrs M=F
Asymmetrical
Shoulder and elbow joint

Mc preceded by diarrhea
Rare/specific skin manifestation - pyoderma gangrenosum

Treatment
NSAIDS

104
Q

Reactive arthritis

A

20-40 yrs M=F
Post infective
Asymmetrical
Knee and ankle joint

Mc preceded by Chlamydia uti
Rare/specific: Keratoderma blenorrhagicum(soles and palms)

Treatment
NSAIDS

105
Q

Extra intestinal manifestations in CD & UC

A

All EIM - mc in CD>UC
Except
Pyoderma gangrenosum - only mc in UC

106
Q

DMARDS

A

Methotrexate - most potent
Sulfasalazine - safe in pregnancy
HCQ - Safest in pregnancy

Together - Synergistic

107
Q

Wegeners granulomatosis

A

Necrotizing Granulomatous vasculitis
Hematuria
Hemoptysis
URT involvement - mc
Skin rash
Ocular★ - pathognomic - pan uveitis

cANCA/PR3 (+)
Lung biopsy

Treatment - cyclophosphamide
70% risk of RPGN

108
Q

Churg strauss syndrome

A

Granulomatous vasculitis
Eosinophilia
Allergic rhinitis
Adult onset asthma - mc

pANCA/Anti-MPO
Eosinophilic infiltrates on skin biopsy
30% risk of RPGN

109
Q

Microscopic polyangitis

A

Mimics PAN

Good response to steroids
10-15% risk of RPGN

110
Q

Type 1 RTA

A

NAGMA + Low UCl- + High urine AG
UpH >5.5
Most severe
Mc inherited
<10yrs, M>F
Short stature
Nephrocalcinosis

111
Q

Type 2 RTA/ proximal RTA

A

NAGMA + Low UCl- + High urine AG
UpH <5.5
Milder

Fanconi’s triad
Glycosuria
Aminoaciduria
Phosphaturia

112
Q

Type 3 RTA

A

NAGMA + Low UCl- + High urine AG
UpH <5.5
Milder
Rare
CA-2 gene
Mc cerebral calcification
Osteopetrosis - 30%

Marble brain & bone disease

113
Q

Type 4 RTA

A

Hyperkalemic RTA
NAGMA + Low UCl- + High urine AG
UpH <5.5
Mildest
Most common RTA
Mc acquired RTA

> 50 yrs, M=F
Early CKD: >25 ml/min

Drugs
ACEi/ARB/K+ sparing diuretics/Trimethoprim

114
Q

Milk alkali syndrome

A

Metabolic acidosis
Renal failure

115
Q

Antibiotics in neutopenic fever

A

Given:
Cefepime
Piptaz
Meropenem

Not given:
Linezolid

116
Q

Rapid correction of hyponatremia leads to

A

Pontine osmotic myelinolysis - Quadriplegia, rigidity, aphonia

117
Q

Hyponatremia correction

A

Total Na deficit: (140 - pt.Na) x body water(0.6 x wt for males and 0.5 x wt for females)

Na. to be given in 1st 24 hrs = (Desired Na. After 24 hrs - initial pt Na. Conc) x body water

Na in the first 24 hours:
Acute: 8 - 10 meq
Chronic: 4 - 6 meq

118
Q

Complicated malaria

A

pH <7.25
Unarousable coma
Glucose <40 mg
S.creatine >3mg/dL
ARDS
SBP <80mmhg

119
Q

Treatment of hyperkalemia

A

Insulin (fastest)
Salbutamol
Calcium gluconate - cardiac stability

120
Q

Drugs for sickle cell anemia

A

L glutamine - antioxidant
Voxelotor - ↑Hb oxygenation
Hydroxyurea - ↑HbF

121
Q

Treatment for Ulcerative colitis

A

<6 stools/day - Mid to moderate
Distal - 5ASA PR
Pancolitis - 5ASA oral

Refractory - Prednisolone

Maintanence - Azathioprine

Severe - IV methyl prednisolone

122
Q

Metabolic syndrome

A

Waist circumference
↑BP
↑Glucose
↑TGs
↓HDL

123
Q

Severity of dengue

A

Warning signs
Persistent vomiting
Hepatomegaly
Severe abdominal pain

Severity
Plasma leakage causing respiratory symptoms (pleural effusion)
Severe bleeding
Organ dysfunction - ALT >1000 or mental confusion

124
Q

CHA2DS2Vasc score

A

Risk of thromboembolism in non rheumatic atrial fibrillation

Congestive heart failure: 1
History of hypertension: 1
Age >75: 2
Age 65-75: 1
Diabetes: 1
Stroke: 2
Sex Female: 1
Vascular event: 1

Warfarin indicated when score>=2

125
Q

Extra intestinal manifestations in crohn’s disease

A

Unrelated to disease activity
Gall stones
Renal calculi
Primary sclerosing cholangitis
Chronic active hepatitis
Sacroilitis

Related to disease activity
Erythema nodosum
Pyoderma gangrenosum
Arthropathy
Eye complications
Aphthous ulcer
Amyloidosis

126
Q

Treatment of crohn’s disease

A

Mild(<4) to moderate (4-6) Budesonide - ileal release
Moderate to severe(7-10) - Oral prednisolone

127
Q

Nelson’s syndrome

A

Pre-existing ACTH secreting pituitary tumor after B/L adrenalectomy for cushing’s syndrome →rapid growth of tumor due to loss of negative feedback

Bitemporal hemianopia
Hyperpigmentation

Treatment
TSR
Pasireotide/Octreotide (statins)
Radiotherapy/Radiosurgery

128
Q

Whipples disease

A

Triad
Fat malabsorption
Migratory Arthritis
Dementia

Biopsy - PAS positive macrophages containing small bacilli

D Xylose test (+)
Schilling test (+)

129
Q

Fibromyalgia

A

↑pain sensitivity
Cognitive defect
Disturbed sleep

Anti polymer antibody

130
Q

ROME 4 criteria

A

Irritable bowel syndrome

• Essential: Abdominal pain > 1day/week for >3 months ( symptom onset >6 months)
+
≥2 of 3
• ↑Pain by defecation
• change in stool frequency
• change in stool consistency

Not seen in IBS - wt loss, blood in stools, nocturnal diarrhoea

Facts (24 decks)

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