MRCP Part 2 Flashcards
MRCP Part 2 Revision
Drusen is in what condition?
Dry ARMD
How does Dry ARMD present?
central vision loss (scotomas) over decades
Treatment of Dry ARMD
multivitamin and antioxidant supplements
What characterises Wet ARMD?
choroidal neovascularisation –> predesposes to rapid visual loss
treatment of wet armd?
anti-vegf
What is a p-axis of +90 to 180 ?
What is a p-axis of -30 to -90?
What is a p-axis of +90 to 180 ? RAD
What is a p-axis of -30 to -90? LAD
Short term use of TPN in recovering chrons, useful or not?
Useful
treatment of gpa (pul/renal syndrome)
cyclophosphamide + methylprednisolone
Ichythosis vulgaris - inheritence
Autosomal dominant, dry scaly skin
treatmnet of invasive aspergillois (pneumonia post cancer rx)
liposomal amphotericin
most common sites for tendon xanthomata
achilles tendon
knuckles
Loa - Loa
1. Type of Microorganism
2. Symptoms
3. treatment
- Nematode (parasite in freshwater)
- Transient subcutaneous swellings (migrates through patients limbs/legs –> after months of initial infection –> numbness, lymphedema /filiarisis)
- Diethylcarbamazine (DEC)
settings in ARDS ventilator
- High PEEP
- Low Tidal volume
- RR up to 35 breaths per minute
what investigations malignant htn
- check end organ damage (eyes, liver), ct head r/o subarachnoid
treatment malignant htn
treatment - labetalol, sodium nitroprusside,
When did Hep C in blood start being screened for?
1990s (so prior = risk of transfusion associated Hep C not B - started in 1980s)
What is achalasia?
What is the Ix of choice and finding?
Rx?
Achalasia = inability for lower esophageal sphincter to relax + absence of normal esophageal peristalsis. Needs to OGD to r/o cancer
Ix of choice = barium swallow = bird beak, oesophagus dilated –>distal esophagus narrowed + oesophageal mannometry = incomplete relaxation in response to swallowing
Rx = myotomy, botox, pneumatic dilation, oral nitrate/ccb
when is exercise electrocardiography in the assessment of CAD / atypical chest pain not useful?
and what is the solution?
1) conduction abnormalities (e.g. RBBB), resting ECG abnormalities (e.g. st depression), WPW, digitalis, ventricular paced rhythm.
2) thallium myocardial perfusion imaging (not dobutamine) - pharmacological rather than exercise induced
treatment TCA OD (e.g. dothiepin, amitryptyline)
IV sodium bicarb + mag sulphate if TDP on ECG, not amiodarone (can prolong AP=> arrythmia)
MRI findings on T2 MS?
cortical and periventricular lesions (high signal change)
triad of fetal alcohol syndrome?
1) mentral retardation/behaviour abnormalities (low IQ)
2) growth retardation
3) mid-facial abnormalities
Optic Neuritis fundoscopy findings
next best investigation once ON confirmed?
- pale optic disc
- MRI brainwith gadalonium
Tocalizumab most concerning sfx
neutropenia/neutropenic infections
Managemetn variceal bleed
- Bloods products / IVF
- terlipressin
- erythromycin
- balloon tamponade
- variceal banding
- TIPS (transjugular intrahepatic portosystemic shunt)
AML - what is on blood film
Blast cells with auer rods
AML - what is associated with unfavourable outcome?
deletion chromosome 5 (5q-)
SAAG > 1.1 causes
SAAG <1.1 causes
> 1.1 = Cirrhosis w/ portal htn, budd-chiari, RHF
<1.1 TB peritonitis, nephrotic syndrome (low albumin), malignancy/pancreatitis
TIA management
- Aspirin 300mg two weeks
- Clopi 75 mg + simsvastatin thereafter
what are the two first line investigation in ovarian masses?
transabdominal USS + CA125
investigation MND
electromyography
Type of membranous nephropathy after kidney transplant?
Membranoproliferative glomerulonephritis
lymphocitic colitis associated with what?
dx?
management?
lymphocytic infiltration of colon, associated w/ chron’s/ibd, and setraline use –> diarrhea
dx colonic biopsy (lymphocitic infiltration)
management - withdraw agent and loperamide, cholestyramine
treatment SBP secondary to continuous ambulatory peritoneal dialysis?
intraperitoneal vancomycin and gentamycin as coagulase -ve staphylococcus is common organism
weight gain + COCP + No periods + carbamazepine cause?
PREGNANCY! CARBAMAZAPINE = CYP450 Inducer = reduces COCP => pregnancy
HTN + renal angiogram shows String of beads on renal artery + Rx
=renal atherosclerosis , rx = angioplasty
cinchonism= what medication and what symptoms
Quinine / Quinidine (Class 1A antiarrythmic - sodium channel blocker slows rapid depolarisation during phase 0) => vomiting, vertigo, tinnitus, headache and blurry vision
PAN
1) type
2) skin changes (2)
3) associated viral
4) renal changes
5) nerve
6) visual
7) anca
8) esr
9) rx
polyarteritis nodosa
1) small-medium sized vasculitis
2) purpura, livido reticularis
3) hep b
4) microaneurysms renal artery
5) mononeuritis multiplex (foot drop),
6) transient visual loss
7) c and p-anca -ve
8) esr raised
9) corticosteroids + cyclophosphamide
ECG findings acute pericarditis
1) concave ST elevation - saddle shaped
2) PR depression II , V6
3) PR elevation aVR
FVC
1) definition
2) normal
3) predictor of what
1) Forced vital capacity (FVC) is the maximum amount of air you can exhale after inhaling fully
2) 3.0-5 L
3) in GBS - FVC = best measure of prognosis
Alcohol pneumonia
1. Cause
2. XR findings
3. Rx
- Klebsiella pneumoniae
- Pneumonia + Lung abscess (cavitation)
- 3rd gen cephalosporins (ceftriaxone) quinolones e.g levofloxacin
Erythema multiforme, cold agglutinin found , AI haemolytic anaemia, reticulocytosis, elevated LDH
diagnosed via?
rx
1) direct coombs + mycoplasma serology
2) macrolides (clarithromycin)
mycoplasma
Famial mediterranean fever symptoms
- recurrent fever
- peritonitis (severe abdo pain)
- pericarditis, pleuritis, synovitis (arthralgias w/ clear fluid aspiration)
- attacks lasting 24-72 hours
- rx = colcichine
achalasia pathophysiology
degeneration of myenteric plexus
AML Dx
- > 20% blast cells in BM or <20% if specific clonal abnormalities seen
- cloncal abnormalities t(8:21)(q22;q22), inv(16)(p13;q22), t(16;16)(p13;q22), t(15:17)(q22;q12)
- monocytoid cells with auer rods
type 1 Amiodarone induced thyrotoxicosis rx (positive thyroid AAbs)
type 2 Amiodarone induced thyrotoxicosis rx (lasts 1-3 months, normal thyroid on exam!)
- carbimazole
- discontinue amiodarone
- prednisolone
- discontinue amiodarone (long half life so controversial 58 days)
raised b-hcg
raised afp
1) seminomatous germ cell tumours - bhcg (with hyperthyroid sx - due to b-hcg acting on thyroid gland - similar structure to tsh, same alpha subunit and similar beta subunit)
2) non-seminomatous germ cell tumours - afp
ABPA
1) blood
2) cxr
3) causes
4) dx
1) peripheral eosinophilia
2) veil like upper lobe collapse , or pulmonary infiltrates
3) causes - asthma
4) dx rast/ igG a. fumigatus, raised IgE>1000
if dried crusted up HZV reactivation rx =?
active infection=?
hzv encephalitis=?
1) dried - gabepentin/pain relief
2) oral aciclovir
3) iv aciclovir
SSRI and warfarin
reduce platelet function so increase risk of bleeding
mirtazapine mechanism
presynaptic alpha 2 adrenoceptor antagonist (increases serotonergic and noradrenergic neurotransmission)
Indinavir
1) type of drug
2) sfx
3) dx of sfx
1) protease inhibitor
2) nephrolithasis
3) urine crystals
Mycoplasma pneumonia
1. first line rx
2. 2nd line rx (or first line if at risk of long qt e.g. if taking amitriptyline)
- =levofloxacin or macrolides
- doxycycline
If ABPA not controlled on oral steroids alone what to add?
oral itraconazole
TTP symptoms (5)
rx
ci
what is cause?
microangiopathic haemolytic anaemia (ldh increase, reticuloycytosis, bilirubin rise, low hb),
thrombocytopenia
neurological abnormalities
fever
renal dysfunction
rx = ffp, methylpred, plasma exchange
CI = platelet transfusion
cause = adamts13 deficiency (can’t cleave platelets so they clot)
MI + GI Bleed (Clopi, aspirin, fondaparineux)
stop fondaparineux only if can (as clopi and aspirin stop stent thrombosis)
most common organisms in cf (pul infiltrates, recurrent chest infections due to bronchiectasis, nasal polyps) , derranged LFTs, pancreatitis, diabetes
- s.a
- pseudomonas aeruginosa
asymptomatic bactiuria
no rx
toxoplasmosis ct findings
rx
ring enhancing lesions (1/2)
sulfadiazine + pyrimethamine + folinic acid + dexamethasone
india ink stain
cryptococcal meningitis (lymphocytosis , low glucose, raised opening pressure, raised protein ) in csf - in hiv
multifocal leukoencephhalopathy organism
hiv - jc virus
rx narcolepsy
modafinil (cns stimulant)
Inclusion bodies colon biopsy UC patient
CMV colitis
(Rx gangiciclovir)
Infective endocarditis in farmer organism
Coxiella
Procycylidine mechanism
Anticholingeric
long qt syndrome rx
1) metoprolol (Metoprolol doesn’t shorten the QT but reduces arrhythmia risk by blunting sympathetic triggers, blocks b1 receptors, Blocks β1-adrenergic receptors → ↓ sympathetic drive
Reduces heart rate and myocardial excitability
Stabilizes the cardiac action potential
Prevents sudden surges of catecholamines that can trigger torsades)
2) ICD
3) left cervicothoracic stellectomy
PPI which vit deficiency can occur?
vit b12 (reduced absorption)
tetanus which NT?
blocks inhibitory NT glycine and GABA
hairy cell leukemia
splenomegaly, anaemia, thrombocytopenia, monocytopenia
abnormal b-lymphocytes with eccentric nuclei / abnormal villous projections
rx purine analogues cladribine, pentostatin
botox which NT?
blocks acetycholine => paralysis
carotid stenosis 90% and squamos cell lung ca left upper lobe - rx? a) pneumonectomy/lobectomy or b) radio/chemo therapy
b) radio/chemotherapy because peri-operative risk is high of stroke
type of white cells seen in pyoderma gangrenosum
neutrophils (neutrophilic dermatosis)
sweets syndrome (triad)
Sweet syndrome is a skin disease that causes a sudden rash, fever, and high white blood cell count. It’s also known as acute febrile neutrophilic dermatosis.
post tbi central obesity, reduced libido , fatigue, reduced muscle mass, secondary to deficiency of which hormone?
growth hormone
septic shock despite 2L fluid resusitation and no improvement bp may require?
ICU input for noradrenaline infusion to maintain an adequate BP
Cowden syndrome
1) inheritence
2) dermatological features
3) malignancies
1) Autosomal dominant
2) hamartomas (A hamartoma is a non-cancerous growth that’s made up of an abnormal mixture of cells. Hamartomas can occur in many parts of the body, including the brain, skin, mouth, and gastrointestinal tract), sclerotic fibromas (on skin), trichilemommas (skin-coloured wart like strucutres)
3) breast ca, thyroid mass/malignancy, colorectal cancer, macrocephaly
alcoholic cardiomyopathy best rx
abstinence from alcohol
brucellosis symptoms
farm worker
(bacteria Brucella abortus zoonotic disease)
–>back pain, constipation, pyrexia of unknown origin, hepatosplenomegaly, unsteady gait, generalised hypotonia
NMS (Neuroleptic malignant syndrome)
Rx
Treatment - IVF, bromocriptine/dantrolene
Dantrolene mechanism
Dantrolene depresses excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor 1, and decreasing intracellular calcium concentration
Bromocriptine mechanism
dopamine agonist
HSP 5 symptoms
kidney complications
thrombocytopenia, purpura (vasculitis - inflammed blood vessels leak into skin), arthritis, abdo pain, haematuria
complication - glomerulonephritis
Types of kidney stones (5) and association
Calcium Oxolate (short bowel syndrome) - most common - Chron’s , resected short bowel, increased oxolate permeability , which is absorbed and excreted in excess therefore, rx calcium citrate supplementation hydration and reduced oxolate..
Calcium Phosphate
Uric Acid (Gout)
Struvite (Proteus)
Cystine (Cystinuria)
Rx ocd
CBT
Ichythosis vulgaris rx
Parrafin containing emollients
Rapidly growing brain tumour with poorly differentiated small round cells
Glioblastoma multiforme
Rx gross total resection , radiotherapy and chemo (temozolamide - oral alkylating agent)
Colon carcinoma and I.E.
Organisms
Rx
Strep bovis
Bacteriodes
Rx metronidazole
Renal flank pain and nephrotic syndrome
Renal vein thrombosis / AKI (hypercoaguable state due to loss of protein c , s , and antithrombin 3)
VT associated with digoxin treatment
IV lignocaine (unless significant cardiovasciular instability
then give synochronised DC cardioversion
onion-skin type periductal concentric fibrosis on biopsy of bile duct
PSC
Budd-chiari syndrome
obstruction of intrahepatic veins - can be a complication of behcets
abdo pain, ascites, and jaundice
(portal hypertension)
raised c-peptide frequent falls
sulphonylurea abuse (increased endogenous insulin production) => hypoglycemia
cryptosporidium diarrhea rx
- parasitic rx - nitazoxanide
- supportive
- rx HIV underlying
Increased chance of Ca on Lung cxr with mulitple noduels
- spiculated margins
- distortion of neighbouring vessels with spiculated margins
- ground-glass shadowing
- cavitation/pseudo cavitation
cxr
1) cavitation
2) pseudocavitation
1) cavitation - gas filled space within nodule, mass or area of consolidation due to necrosed lung tissue
2) pseudocaviation - resemeble cavitaties but are dilated bronchioles or small cysts (air/fluid filled)- can be due to adenocarcinoma, emphysema
1) gram -ve diplococci STD
2) rx
1) n. gonorrhea
2) Im ceftriaxone
when to take levodopa
improved diet - take 60 mins before eating to prevent motor - on/off symptoms (as its absorbed in duodenum) as dietary proteins can compete for its absorption and transport in gi system and to bbb reducing its effects
erythema nodosum histocompatibility
hla b27
kallman vs klinefelter
kallman - hypogonadotropic hypogonadism (low LH)
klinefelter - 47xyy - primary hypogonadism (raised LH)
immediate rx graves eye disease
iv glucocorticoids
zidovudine mechanism
sfx (2)
1) nrti
2) dilated cardiomyopathy
3) lipodystrophy on bloods (high tg for example)/insulin resistance
Multifocal Motor Neuropathy (MMN)
Sx (3)
Abs
Rx
motor only, assymetric weakness, LMN signs,
GM1 antibodies (anti-ganglioside)
rx IVIG
most common cause meningitis after neurosurgical procedure
rx
staphylococcus epidermidis/aureus
rx - vancomycin for staph epidermidis (coagulase -ve and resistant to penicillin)
Leishmaniasis (cutaneous)
-south america, south asia
rx
small papula initially then ulcerates, spread by sandflies (parasitic disease
rx sodium stibogluconate
leishmaniasis visceral (kala-azar) - africa, brazil, south asia
fever, weight loss, hepatosplenomegaly –> anaemia and fatigue,
rx liposomal amphotericin B
Chronic Eosinophilic Pneumonia vs ABPA
ABPA - Aspergillus total serum IgE and IgG precipitins towards Aspergillus Fumigatus
CEP - Raised total IgG, asthma peripheral infilitrates, simlar to ABPA, rx steroids
otits externa most common organism (2)
pseudomonas aurgineousa, staph aureus
diabetic and I.C
sporadic cjd sx
consider encephalitis (change personality, neuro signs) and myocolonus and rapidly progressing dementia
investigations - CSF analysis for 14.3.3 protein and RTQuIC
burkitss lymphoma in colon
high LDH and uric acid (tumor lysis), over days/weeks - very rapid doubling time (25H)
rubeosis iridis
rx
neovascularisation of the iris
rx - panretinal photocoagulation, anti-vegf
Spinal muscular atrophy type 3
(degeneration motor neurons)
1) inheritence
2) symptom progression
3) dif w/ type 1
AR -> progressive LMN weakness , then later bulbar weakness (pneumonia/resp failure) , parents first cousins
type 1 = onset before 6 months
type 3 = child to adolsecent, less sever
prolonged aptt in APL
due to lupus anticoagulant binding phospholipids in lab tests
viral vs bacterial gastroenteritis
viral - non-bloody often (norovirus, rotavirus, enteric adenovirus, astrovirus)
bacterial - bloody often (most common - c. jejuni, salmonella , shigella)
raised ICP
triad symptoms
ix
worse headache in morning, b/l papilledema, cranial neuropathy
ix - cranial imaigng (CT, MRI), r/o SoL
oncogenic osteomalacia
low vit d secondary to cancer (e.g. CLL)
- malignancy produces FGF23 –> reduced 1,25 dihydroxy vit d by kidneys and phosphate reabsorpation
–> low phosphate (rickets, osteomalacia),
rx - vit d and phosphate supplements
treatment for pseudomonas
IV tazocin
or oral fluoroquinolones
GI haemorrhage, microcytosis , and worms on ogd
1) organsims
2) rx
hookworm - Necator americanus
, ancylostoma duodenale
rx - albendazole, mebendazole
reversible cerebral vasoconstriction syndrome
1) sx
2) mri findings
3) secondary causes
1) seconds to minutes episodes of worst headache
2) multisegmental cerebral artery vasoconstriction
3) pseudoephirene (vasoconstrictor), triptans,
4) rx - management bp - labetalol, ccb
management of venous ulcers
multi-layers compression banding
mantoux test in HIV and TB
mantoux test can be -ve
Clarithromycin and amlodipine
reduce dose amlodipine when starting clari,
macrolides inhibit cyp3a4 (amlodipine metabolised by cyp3a4) => increase vasodilatory effect/renal injury
Bartter
Gitelman
Liddle
Bartter = Like loop diuretics (blocks NKCC2) → hypercalciuria
Gitelman = Like thiazide diuretics → hypocalciuria + hypomagnesemia
Liddle = Looks like hyperaldosteronism but aldosterone is low
all are inherited renal tubulopathies
All have hypokalemia + metabolic alkalosis
1) Bartter - NKCC2 inhibiton (Na⁺/K⁺/2Cl⁻) thick ascending limb LOH, hypercalciuria, sodium loss, normal/low bp, increased AR, autosomal recessive
2) Gitelman - NCC inhibition (Na⁺/Cl⁻ co-transporter (NCC), DCT, hypocalciuria, sodium loss, normal/low bp,
-low magnesium, increased AR, autosomal recessive
3) Liddle - ENaC- gain of function, sodium reabsorption, htn in youth, normal Mg, normal calcium, reduced AR, Autosomal dominant
Whipple’s disease
1) Cause
2) symptoms
3) dx
4) treatment
1) Tropheryma whipplei (a gram-positive actinomycete) + Immune response - multisystem but GI predominant
2)
CAN MALA
C- Chronic diarrhea, abdo pain, fever
A- Arthralgia
N- Neurological (dementia, myoclonus, ataxia, etc.)
MALA - Malabsorption (steatorrhea, WL, anameia)
3) dx - jejunal biopsy- macrophages + for Periodic acid schiff staining , HLAB27
4) rx lt abx that cross bbb
Initial IV antibiotics (to penetrate CNS):
Ceftriaxone or penicillin G for 2–4 weeks
Followed by long-term oral therapy (to prevent relapse):
Trimethoprim-sulfamethoxazole (TMP-SMX) for 12 months
Aspergilloma xr
rounded opacity surrounding by halo of air
similar px to tb - wl, haemoptysis
isotretinoin blood level sfx
thrombocytosis, thrombocytopenia, anemia, raised esr
liquorice poisoning findings
in chinese remedies, hypokalemia, htn, metabolic alkalosis, normal r:a
R:A in renal artery stenosis
Renin ↑ High
Aldosterone ↑ High
RAR Normal or ↓ Low
Acute Intermittent Porphyria
1) Pathophysiology
2)sx
3) ix
4) Rx
1) Haemoglobin made from haem + globin
–> haem made from protoporhyrin 9 and Fe2+. Porphyria is AD due to defect in porphobillinogen deaminase, required to make up protoporphyrin 9 –> toxic porphyrin precursors triggered by stressors (drugs-sulphonamides, baributrates, ocp, anti-epileptics), fasting, alcohol, hormones (attack in luteal phase due to increased progesterone)
2) 4 P’s
Pain - abdo pain (w/o peritonitis)
Psych - anxiety,hallucination, agitation
Peripheral - Peripheral neuropathy
Pink/Purple Urine (on standing urine becomes darker tdue to porphyrins)
3) PBG increased in attack, ALA, urine and faecal porphyrins,
4) IV hemin (feedback inhibition of ALA synthase)
High-dose glucose (inhibits ALA synthase)
ALA is neurotoxic and leads to symptoms
angioedema htn med
ramipril
fat embolism rx
iv fluids, supporitve
Pul HTN diagnosis
1) ECG
2) PAP
3) PDE5
1) RVH , RAD, P pulmonale
2) Pul artery pressure via RH catheterisation >25 mmHg
3) PDE-5 Inhibitors - sildefanil
endothelin receptor blocker - bosentan
prostacyclin analgoues (PGI2) - iloprost
CCB - if +ve vasodilator test = first choice.
AVT - Acute vasodilatory testing
Acute vasoreactivity testing (AVT) is a key diagnostic step during right heart catheterization in patients with pulmonary arterial hypertension (PAH) to identify those who might benefit from calcium channel blockers (CCBs).
if mPAP drop >10 mmHG
if not then can go to targetted pul htn therapies
HHT -
triad
Hereditary hemorrhagic telangiectasia (HHT) – telangiectasia , autosomal dominant, AVMs in lungs, GI, brain (Haemorrhage)
bird fanciers lungs
1) alternative name
2) cause
3) PFTs
4) rx
1) extrinsic allergic alveolitis (type of ILD)
2) hypersensistivity pneumonitis due to inhaler avian proteins in feathres (IgA)
3) reduced tlco, reduced kco,
4) corticosteroids, avoid allergen
other causes EAA (2)
farmers lung - Micropolyspora faeni, thermatinomyces in hay,straw,grain
malt workers - aspergiullus clavatus
causes upper zone fibrosis (7)
coal workers pneumoconiosis
ankylosing spondylitis
sarcoid
silicoid
TB
EAA
Radiation
treatment of anterior uveitis
steroids (topical/oral)
medications that cause raynauds
beta blockers, vinblastine, bleomycin, ocp, ergotamine
safe dmards in preg (3)
SSZ, leflunomide, AZA
but mostly SSZ
2 causes unconjugated hyperbilirubinaemia
2 causes conjugated hyperbilirubinaemia
1) unconjugated
gilberts syndrome , criggler najjar (ugt1a1 gene defect => udp glucuronyl transferase) deficiencies
2) conjugated - transport deficiencies)
dubin-johnson (MRP2 def) (dark granules within hepatocytes)
rotor (OATP def) (normal liver histology)
treatment entemeba histolytica treatment abscess
aspirate + 10 days metronidazole
Acute anterior ischemic optic neuropathy vs Central retinary artery occlusion
AION - ischemia of optic nerve head - supplied by posterior ciliary arteries - e.g. secondary to vasculitis/GCA
CRAO - pale fundus with cherry red spot at macula , no disc swelling (embolic/thrombic)
both painless monocular vision loss
rx pyoderma gangrenosum (starts at papule/pustule then ulcerates in IBD ptx)
1) topical/oral steroids
2) iv infliximab
acute tubulo-intestitial nephritis
1) dx
2) secondary to
3) rx
1) renal biopsy, low urine, low osmolality, ur:cr <40
2) abx (pen, ceph), nsaids, allopurinol
3) conservative unless uremic
AI hepatitis
abs
T1-ASMa
T2-A-LKM
T3 -Soluble Liver-Kidney Ag
all have gamma-globulin ag raised
all respond to steroids
McArdle syndrome
1) enzyme deficiency
2) second wind
3) lactate levels (serum lactute post exercise is important)
4) blood in urine
1) muscle glycogen phosphorylase deficiency => inability to breakdown glycogen in muscle =>accumulation of glycogen and early fatige
2) second wind when switch to aerobic respiration using glucose frmo blood
3) no raised lactate (deficient glycogen/glucose to lactate)
4) Possible myoglobinuria (cola-colored urine) after strenuous activity → risk of acute kidney injury
the enzyme deficiency limits
ATP generation by glycogenolysis and results in glycogen
accumulation
Treatment for muscle phosphorylase deficiency consists of
preexercise consumption of simple carbohydrates (e.g., sucrose or
sports drinks) to protect muscles and improve exercise tolerance
prior to the onset of the second wind
lofgrens syndrome
acute sarcoidosis
erythema nodosum, bhlad, joint sx
loeflers syndrome
eosinophils in lungs due to parastitic infection (ascarisis lumbricoides)
caplans syndrome
pneumoconiosis + RA => rheumatoid nodules in lungs
Pneumoconiosis refers to a group of interstitial lung diseases caused by inhalation of inorganic dusts, leading to chronic lung inflammation and fibrosis.
hepatorenal syndrome pathophysiolgoy
- Liver Disease Leads to Increased Vasodilators
In cirrhosis or portal hypertension, the liver fails to clear vasodilatory substances (especially nitric oxide).
This causes systemic and pulmonary vasodilation.
- Intrapulmonary Vascular Dilations (IPVDs)
Pulmonary vessels, especially at the bases, become abnormally dilated.
Capillaries widen → oxygen molecules can’t efficiently diffuse across the increased distance → impaired oxygenation.
- Ventilation-Perfusion (V/Q) Mismatch
Blood flows through dilated vessels too quickly, and/or too far from alveoli, causing inadequate oxygen exchange.
Also contributes to a right-to-left intrapulmonary shunt (blood bypasses oxygenation).
- Result: Hypoxemia
Arterial blood has low oxygen content despite normal or increased ventilation.
Positional hypoxia (worsens when upright) = platypnea–orthodeoxia syndrome
Platypnea = Shortness of breath that worsens on sitting or standing (opposite of usual cases)
Orthodeoxia = Drop in oxygen saturation when moving from lying down to standing
Intrapulmonary vascular dilatations (IPVDs) are more prominent in the lung bases (due to gravity and regional blood flow).
When you stand up:
Blood is redistributed more toward the lower zones of the lungs.
These dilated vessels act like a shunt — blood flows through them without getting properly oxygenated.
More blood flows through poorly oxygenated areas, leading to worsening hypoxemia.
When lying down (supine):
Blood flow is more evenly distributed throughout the lungs.
Less shunting → better oxygenation
Treatment is with oxygen supplementation and
liver transplantation
most useful med post MI
beta blockers
diabetes insipidus ix + values for test
cranial di - post desmopressin test urine osmolality >660 , little to no response in nephrogenic diabetes insipidus
rx cranial di
intranasal desmopressin
rx nephrogenic di
stop offending agent or hypokalemia/hyperca
bendroflumethiazide
sarcoid granuloma biopsy finding
granuloma with prominent epitheloid cells with sparse lymphocytic infiltrate at the margins
alien limb phenomenon, unilateral tremor, myoclonus, apraxia (inability to carry out purposeful movement), non-fluent aphasia
Corticobasal degeneration
alveolar microlithiasis
1) inheritence
2) pathophysiology
1) AR
2) calcified microliths in alveolar space
pseudohypkeralemia
in sample tube for lt or secondary to essential thrombocytosis => hyperkalemia => in tube lysis
paracetamol overdose indicators of liver damage (5)
PT>100 (most sensitive)
serum cr >300
arterial ph < 7.3
INR>6.5
grade 3 or 4 hepatic encephalopathy
pemphigus vulgaris
vs
bullous pemphigoid
p.v - flaccid and mucous membranes
b.p - tense blisters
rx - steroids
bordatella pertussis bacteria shape and gram
gram negative coccobaccilus
macrolides only useful if used in first 3 weeks
thumbprinting on axr
ischemic colitis (represent thickening of the colonic haustral folds and are a sign of severe submucosal edema)
When is useful to give lorazepam as an antiemetic
When given with other antiemetics (additive effect)
Virus in past after blood product donation transmission
Hep C
Signal increase temporal lobes MRI suggest
HSV encephalitis
ECG changes Li toxicity
Prolonged QTc and flat t waves
Osteomyelitis
1) most common in diabetics
2) most common in non diabetics
1) S.A
2) p. Aeruginosa
HAP organisms most common + 2others
rx
- Pseudomonas Aeruginosa
- Klebsiella Pneumoniae
- MRSA
rx- piperacillin tazobactam
high protein in csf, no raised wcc, lmn signs
1. whats it called
2. what does it indicate
cytoalbuminogenic dissociation
-gbs
rx diptheria
- diptheria antitoxin + erythromycin
treatment course stroke if woken up from stroke
if woken up with symptoms - no thrombolysis/thrombectomy
just give aspirin 300mg
alports syndrome w/ renal transplant + new AKI/CKD
think anti-gbm disease (as alports = abs to collagen t4) => rpgn w/o pulmonary haemorrhage
myelocytes + nucleated red blood cells=?
associated w/?
leucoerythroblastic anemia
myelofibrosis, cml, myeloma, malignant marrow infiltration, polycythemia rubra vera, sarcoidosis, tb of bone marrow, osteopetrosis
non-specific urethritis
how its discovered
organisms
rx
dysuria -> neutrophil on penile swab no organisms on microscopy
due to ureaplasma urealyticum, mycoplasma genitalum
rx doxycycline *first line or azithromycin if allergic
tumour lysis syndrome (rapid breakdown tumour cells after chemo)
potassium
calcium
phosphate
uric acid
kidney
ldh
prevention
rx established
hypokalemia
hypocalcemia
hyperphosphatemia
hyperuricaemia
AKI
raised LDH
give allopurinol to prevent it (inhibit xanthine oxidase prevents uric acid formation)
rx-
rasburicase (converts uric acid to allantoin in established TLS - more soluble)
ivf , correct electrolytes
?dialysis
mechanism of ascites in cancers (5)
- peritoneal carcinomatosis (tumour cells infiltrate peritoneum - disrupt normal fluid absorption and leak protein fluid into peritonealcavity)
- obstruct lymphatic drainage (cant reabsorb peritoneal fluid)
- increased capillary permeability (cytokines increase vascular permeability - relased by tumours)
- portal hypertension (e.g. hepatic mets or primary liver ca)
- hypoalbuminaemia (due to cytokine release - supressing hepatic albumin production = negative acute-phase reactant, liver dysfunction, increased cap permeability, protein losing enteropathy - direct damage to gi mucosa, malnutrition & cahcexia)
EPO not working in ckd patient
because not enough iron - give it IV (w/o iron cant build haemoglobin in RBCs!!) oral poorly absorbed
HOCM
Heart sounds
Murmur
Valsalva/Standing
Squatting/Handgrip
pathophysiology
1) S4 (stiff LV)
2) Ejection systolic murmur left lower sternal border - doesn’t radiate to carotids
3) Valsalva - decreasaes preload (less venous return -> worse obstruction of LV outflow tract) =>murmur louder
4) Squatting - increases preload and afterload, more blood in heart increasing chamber size pushing hypertrophied septum out the way/reducing LV outflow tract) = quieter murmur
5) AD mutations in sarcomere - b myosin heavy chain (MYH7 gene) and myosin binding protein c (MYBPC3 gene)=> myocyte hypertrophy, disarray, and fibrosis + assymetric septal hypertrophy (LVOT) anterior mitral valve pulled towards septum during systole (sysolic anterior motion => dynamic obstruction) => mitral regurg
+ diastolic dysfunction (impaired relaxtion and filling) => elevated lv end diastolic pressure => pul congetsion and dyspnea,
thickened myocardium => more o2 req => angina with normal coronaries
arrythmias due to fibrosis/myocyte disarray (AF, VT,SCD)
systolic hf
inability of lv to contract forcefully (dilated cardiomyopathy) unlike s4 = hypertrophic cardiomyopathy
also due to htn , aoritc regurg
dermatitis herpetiformis rx
1) gluten free diet
2) dapsone
3) sulfapyridine
enzyme that is activated by macrophages in sarcoid granuloma
1-alpha hydroxylase
cyanide poisoning
1) cause
2) sx
3) rx
1) sodium nitroprusside stored in sunlight
2) hypertension, bradycardia, then hypotension and coma
3) rx sodium thiosulphate, dicobalt edetate, sodium nitrate (any)
Normal pul artery pressure (if raised = pul htn)
normal r atrial pressure (if raised = RHF
low = low fluid status)
Pul wedge pressure (= L atrial pressure
12-16 mmhg Pul Art
2-6 mmHg R atria
8-10 mmHg (L atria) Pul artery wedge
15-30 R ventr
protein c deficiency , protein s deficiency, factor v leiden, antithrombin 3 def all examples of
thrombophilic disorders
protein c & s def mechanisms
factor v leiden
both are natural anticoagulants, that bind and inactivate factor v and factor 8
factor v leiden - unable to respond to protein c and cant inactivate factor v
if not raised by pituitary tumour and diagnosed acromegaly (via IGF1 then ogtt/GH supression test) - what is another cause of raised GH
carcinoid syndrome
- do ct chest and abdo
diagnosis carcinoid
5 HIAA urinary
Plasma CgA
Seurm seratonin
CT to look for primary
nephrogenic systemic fibrosis
after patients with MRI in ckd patients get gadolinium contrast –> they develop symptoms of systemic sclerosis, autoabs all negative
mixed connective tissue disorder
does not fit into any single category
-serositis, pul febrisosi, pericarditis, sclerodactylyl etc.
anti-rnp postive almost always
clicking sound with heart sounds
small l apical pneumothorax
if pa and AP cxr normal
consider lateral decubitus
Cholesterol Embolism sx (3)
e.g. in leg post-procedure (cholesterol dislodged) - angiography/stenting/carotid endarterectomies/initiating warfarin
AKI, eosoinophilia, distal limb rash livido reticularis
Eosinophilia is part of the immune response to the cholesterol emboli.
Livedo reticularis is caused by microvascular obstruction and impaired circulation due to emboli.
AKI results from vascular obstruction and ischemia in the kidneys caused by the cholesterol crystals lodging in renal vasculature.
Altitude illness - 3 types
1) name types
2) sx
3) rx
1) Acute Mountain Sickness (AMS), High altitude pulmonary edema (HAPE), High altitude cerebral edema (HACE)
2) AMS - headache, N&V, HAPE - cyanosis, chest pain, rapid breathing, HACE - confusion, headache
3) AMS - acetazolamide, HAPE - o2, nifedipine, HACE - dex, o2
all need descent
acetazolamide - causes intracellular acidosis , shifts o2 dissociation curve to right = so low PP - more o2 to tissues
AMS: Hypoxia-induced vasodilation in the brain, cerebral edema, and altered neurological function.
HAPE: Pulmonary vasoconstriction, excessive fluid leakage into alveoli, and impaired gas exchange.
HACE: Cerebral vasodilation and increased blood-brain barrier permeability leading to cerebral edema and increased intracranial pressure.
worst prognosis in multiple myeloma
Beta-2 Microgloblin (increased tumour burden, renal failure)
Hookworm infection
1) organisms
2) route of transmission
3) symptom progression
4) when can see eggs in stools / ix
5) medications
1) ancylostoma duodenale, necator americanus
2) via feet
3) intense local rash then to lungs where cause wheeze and cough then migrate to intestine, become adult and leave eggs => abdo pain, diarrhea, anaemia
4) 8-12 weeks see hookworm eggs in stools
5) anthelminthic drugs - mebendazole, albendazole, thiabendazole , ivermectin
initial rx microprolactinoma
bromocriptine, carbegoline (DA’s)
9:22
ALL
o2 dissociation curve
x axis pO2 (mmHg)
Y-axis % saturation hb with o2
S shaped curve
at higher o2 saturations , hb almost fully saturated
and lower o2 saturations, hb less saturated
R shift = decreased affinity of hb for o2, more to tissues
causes =
CADET, face Right! →
↑ CO₂, ↑ Acid (H⁺) = (↓ pH), DPG (2,3-BPG), Exercise, Temperature ↑
HbF = increased affinitiy of hb for o2
↓ CO₂, ↓ H⁺ (↑ pH), ↓ temp, ↓ 2,3-BPG, CO poisoning, fetal Hb
Left-shifted curve: helps fetus extract O₂ from maternal blood
CO greater affinity of Hb than O2 by 200x (l ward shift)
what is 2,3-bpg
what increases
what reduces it
2,3-Diphosphoglycerate (2,3-DPG) is produced in red blood cells via a side pathway of glycolysis (the Rapoport-Luebering shunt).
It binds to deoxygenated hemoglobin and reduces its affinity for oxygen → facilitates O₂ release to tissues.
Decreases 2,3-DPG — “SAFE blood” holds oxygen tight
Reduces oxygen delivery to tissues (left shift).
Promotes oxygen unloading to tissues.
HATCHET
Hypoxia – triggers 2,3-DPG to help release more O₂ to low-oxygen tissues
Altitude (high) – low atmospheric O₂ → compensatory increase in 2,3-DPG
Thyrotoxicosis – increased metabolism drives glycolysis and 2,3-DPG production
Chronic anemia – fewer RBCs → body increases 2,3-DPG to maximize O₂ delivery
Heat (elevated temperature) – speeds up metabolism and glycolytic activity
Exercise – increased oxygen demand boosts 2,3-DPG for tissue delivery
Talks alkalosis (↑ pH) – alkalotic conditions enhance 2,3-DPG synthesis
SAFE
Stored blood – 2,3-DPG degrades over time, reducing O₂ release capacity
Acidosis – acidic conditions inhibit enzymes that produce 2,3-DPG
Fetal hemoglobin (HbF) – naturally has low affinity for 2,3-DPG → higher O₂ affinity
Electrolyte issue: Hypophosphatemia – phosphate is needed for 2,3-DPG synthesis2
HIV, LAD, multiple nodule changes on imaging, bronchiectactic changes, productive cough
Mycobacterium avium intracellulare, CD4 count<50
What are the risk factors for haemorrhagic transformation after ischaemic stroke?
Large infarct, cardioembolic stroke, thrombolysis, anticoagulants, hypertension, hyperglycaemia, old age, early reperfusion, poor collaterals, BBB disruption, thrombocytopenia, and high NIHSS score.
Mnemonic: “CHART HOP BLEED”
C - Cardioembolic stroke
H - Hyperglycaemia
A - Anticoagulants
R - Reperfusion (early)
T - Thrombolysis (tPA)
H - Hypertension
O - Old age
P - Poor collaterals
B - BBB disruption
L - Large infarct
E - Elevated NIHSS score
E - Endothelial injury
D - Decreased platelets
Post h. pylori rx
patients no longer at risk of MALT lymphoma
myasthenia gravis dx
anti-acetylcholine receptor abs
repetive nerve stimulation/single fibre emg
tensilon test
oral ulcers in SJS rx
chlorhexidine but needs hospital
yellow nail syndrome triad
primary lymphedema, yellow nails, recurrent pleural effusions
Impaired or malformed lymphatic vessels → ↓ lymph drainage
Leads to:
Peripheral lymphedema
Pleural effusions
Sinus and respiratory tract congestion
Also affects nail matrix → yellow discoloration, thickening, and slow growth
1) treponomal tests
explain
2) non-treponomal tests
explain
3) FPs
1) TPHA/FTA-ABS
Detect T. pallidum-specific antibodies, used for confirmation, stay positive for life.
2) VDRL/RPR
Detect antibodies to host lipids, used for screening & monitoring, false positives from viral infections, pregnancy, autoimmune disease.
False positives: Non-treponemal = “V-PRAISE Me” (viral, pregnancy, RA, autoimmune, IVDU, SLE, elderly); Treponemal = rare, sometimes autoimmune or cross-reactivity.
Treponomal = if negative = no syphilis, if positive move to RPR
RPR = positive in active syphilis , can be used to monitor treatment.
+ T + RPR = active syphilis
+ T - RPR = past syphilis or latent
- T - RPR = No syphilis
- T + RPR = FP
“P-VIRAL” mnemonic:
Pregnancy
Viral infections (HIV, hepatitis)
IV drug use
Rheumatic/autoimmune (e.g., SLE, RA)
Ageing
Leprosy / Malaria / TB
explain yaws
Yaws is a chronic skin, bone, and cartilage infection caused by:
Treponema pallidum pertenue
Endemic in tropical rural regions: Africa, Asia, South America, Pacific Islands
Direct skin-to-skin contact with infectious lesions
No insect vector, no sexual contact involved
single dose iv ben pen
Primary Yaws: Starts with a painless papule (called “mother yaw”) that ulcerates and crusts.
Secondary Yaws: Multiple skin lesions appear (papules, nodules, ulcers), often with bone pain and swelling.
Common bones affected: Tibia, fingers, and toes — periostitis is typical.
Other features: Lymphadenopathy, mild fever, and malaise may occur.
Tertiary Yaws (rare): Causes deep ulcers, bone destruction, nasal deformities (goundou), and facial disfigurement.
No CNS or heart involvement (unlike syphilis).
fx of adenosine on
st
afib
aflut
avnrt
avrt
vt
Sinus tachycardia
Transient atrioventricular (AV) block
Atrial fibrillation
Transient AV block
Atrial flutter
Transient AV block
Atrioventricular nodal re-entrant tachycardia (AVNRT) May terminate
Atrioventricular re-entrant tachycardia (AVRT)
May terminate
Ventricular tachycardia
Likely to have no effect
aflut vs afib
aflut = reentrant circuit in RA, regular (unless variable block) = rx with ablation
afib = multifocal disorganized electrical impulses, irregularly irregular = rate/rhythm ctrl, anticoag
theophyline toxicity meds
rx svt asthmatics/copd
macrolides, ciprofloxacin, cimetidine, allopurinol, ocp
rx in asthmatics svt = verapamil
best seizure meds in palliative care first line
levetiracetam
normal ag
ag calc
4-12
na+-hco3-cl
causes of NAGMA
Mnemonic – HARDASS
H – Hyperalimentation (TPN)
A – Acetazolamide
R – Renal tubular acidosis (RTA) - R = renal tubular acidosis (Type I = distal; Type II = proximal; Type IV = hyporeninemic hypoaldosteronism.
D – Diarrhoea
A – Addison’s disease
S – Spironolactone
S – Saline infusion (0.9% NaCl)
F - fistula (URETEROENTEROSTOMY)
