MRCP Word Ax Flashcards
Chemo peripheral neuropathy
Vincristine
Cisplatin
Chemo cardiomyopathy
Doxorubicin
Chemo pulmonary fibrosis
Methotrexate
Chemo haemorrhagic cystitis
Cyclophosamide
Anti epileptics safe in pregnancy
Levetiracetam
Lamotrigine
Cereberal Toxoplasmosis Tx
Sulfadiazine, Pyrimethamine
Histology Barretts Esophagus
Columnar metaplasia
Electrolyte abnormality worsening digoxin toxicity
Hypokalaemia
Hormone that stimulates hunger
Grehlin
Hormone that suppresses hunger
Leptin
Leukaemia “ Broad based projections”
Dry tap
TRAP +ve
Hairy Cell Leukaemia
Worse prognosis RA
Female
Anaemia 3 months
Gradual onset
+ve IgM RF
+ve CCP
Rash with one “herald patch” then spreads
Pityrisias Rosea
Lewy Body Dementia
EPSs
Hallucinations
Variable sx/GCS
Most common Lupus Antibodie
ANA
Translucent bands bones
Osteomalacia
Punched Out Osteolytic Lesions
Myeloma
Nephritis postive for everything
C3, C4, IgM, IgG
Lupus Nephritis
Neck + shoulder pain, weakness abductor pollicis brevis, pin and needles
Cervical Rib
Polymyositis Antibody
Anti Jo
TB Drugs peripheral neuropathy
Isoniazid
Wernickes vitamin deficiency
Thiamine B1
Feltys Syndrome
Triad : Leucopaenia + RA + Splenomegaly
(lympadenopathy, leg ulcers, normocytic anaemia)
Tense blistering rash (not affecting rash)
Bullous Pemphigoid
IgG
Farm, haemolytic anaemia, high billrubin, neurology
TTP
Diabetic meds causing hypos
Gliclazide
Negatively bifringent crystals joint asp
Monosodium Urate Monohydrate
Gout
Weakly positive bifringent crystals joint asp
Calcium pyrophosphate
Pesudogout
Tx Tourettes
Risperidone
Palmar crease xanthaoma (pathognomonic)
Broad beta disease
Subchondral cysts
OA
Periarticular osteopaenia
RA
Osteophytes
OA
Allopurinol on INR
High
St Johns Wort on INR
Low
Carbemazepine on INR
Low
Phenytoin on INR
Low
Rifampicin on INR
Low
Brown/blue pigmentation
Alkaptonuria
Homognetistic oxidase deficiency
Williams Syndrome
Friendly
Short
Neonatal hypercalcaemia
Supravalvular aortic stenosis
Isoniazid on INR
High
Cipro/erthryo on INR
High
SSRI on INR
High
Fluconazole on INR
High
Cushing K+/pH
Hypokalaemia Alkalosis
Conns K+/pH
Hypokalaemia Alkalosis
Bloody diarrhoea w/ shistocytes
E coli
Main bug causing HUS
E coli
Phenylketonuria
Seizures
Eczema
LD
Musty
Burkitts lymphoma oncogene and chromosome
c MYC
t8:14
Neuroblastoma oncogene
n MYC
Cancer type most like to cause hypercalcaemia
Squamous Cell
Waldenstroms Macroglobulinaemia Ig?
IgM kappa paraprotein
Waldenstroms Macroglobulinaemia
HYPERVISCOCITY
Cryoglobulinaemia/Raynauds
Hepatosplenomegaly
Lymphadenopathy
Lebers Optic Neuropathy inheritance
Mitochondrial
Downs syndrome genetics
Trisomy 21
- non dysjunctional mainly
- moasicm (less severe)
- Robertonism (parental issue)
Downs cardiology issues
ASD
PDA
Fallots Tetralogy
Endocardial cushion defect
Downs syndrome ax illness
Duodenal Atresia
Leukaemia
Esophageal fistulae
Hypothyroid
Edwards syndrome genetics
Trisomy 18
Edwards syndrome features
Retardation, craniofacial abnormalities (prominent occiput, low-set
ears, micrognathia).
‘Rocker bottom’ feet
Cardiac abnormalities.
Pataus syndrome features
Mircopthalmia
Cleft palate
Polydactly
Mental retardation
Cri du chat features
Retardation
High pitched cry
Epicanthal folds
Low set ears
Spasticity
Cri du chat genetics
Chromosome 5 deletion
Prader Willi Genetics
microDeletion chromosome 15-11-13
Prader Willi features
P WILLIS
Paternal inheritance
Weight increased
LD
Low muscle tone
Infertility/hypogonadism
Short stature
Angelman syndrome features
Maternal inheritance
Hypertonia
Prominent jaw
Deep set eyes
Absent speech
Retardation
What is Philadephia chromosome
Due to deletion of long arm 22, usually on 9
Prognosis worse without it
Also myelofiborosis, polycythaemia vubra vera
Turners syndrome genetics
45 XO
Non disj/moacism
Turners syndrome cardiac issues
Coarctation aorta
Bicupsid aortic valve
Turners hormones
High gonadotrophin
Low estrogen
Noonans syndrome genetics
45 XY
Noonans features
male turners
absence testicles/crypto orchidism
Kleinfelters genetics
47 XXY XXXYY XXYY
Kleinfeltoms features
Tall, thin, gynaecomastia, infertility
High urinary gonadotrophins
Fragile X genetics
X linked dominant
expansion CGC
Long arm X
Fragile X features
Retardation - severe in males, less in females
Triple X Syndrome
47 XXX
Only slight intelligence impairment
Fertility normal
Women affected more than male genetics
X linked
Mitochondrial inheritance
Maternal transmission
V rare
Leber optic neuropathy
Trinucleotide repeat disorders
Huntingtons, MD, Freidreichs, Fragile X
FH inheritance
Autosomal Dominant
MD Inheritance
Autosomal Dominant
Marfans inheritance
Autosomal Dominant
Alpha 1 antitrypsin inheritance
Autosomal recessive
Wilsons inheritance
Autosomal recessive
Duchenne dystrophy inheritance
X linked recessive
Li Fraumeni Syndrome
Loss of p53 cancer syndrome
Breast, brain, sarcoma
Retinoblastoma chromosome and inheritance
Autosomal dominant
13q14
FAP chromosome
Bowel cancer
deletion 5q21
Colorectal carcinoma chromosome
18q deletion
Haemochromatosis HLA
HLA A3
Behcets HLA
B5
HLA B27
Ank spod
Reiters
Psoriatic arthritis
Anterior uveitis
HLA DR2
MS
Pernicious anaemia
Nacrolepsy
Juvenile diabetes
HLA DR3
Coeliac
Sjogens
Hepatitis
Addisons
SLE
Graves, Hashimotos
IDDM
MG
RA HLA
HLA DR4
Coeliac HLA
HLA DR5, DR7
Gram positive rods
Bacillus
Clostridium
Listeria
Gram positive cocci
Strep
Staph
Gram negative rods
Klebsiella
Enterobacter
Salmonella
Shigella
Legionella
Campylobacter
Pseudomonas
Gram negative cocci
Neisseria
Q fever bug
C burnetti
Most common transmission Hep C
Contaminated blood transfusion
IVDU
(also sex, vertical)
NO VACCINE
Chronic complications Hep C
Cirrhosis
Hepatocellular carcinoma
Dengue features
fever
headache
retro orbital pain
back ache
rash
mucosal haemorrhage, shcok
HIV genetics
single stranded RNA
Immune changes in HIV
decreased CD4, CD8
hypergammaglobulinaemia
decreased macrophage
Virus causing T Cell leukaemia
HTLV 1
Virus causing Kaposis sarcoma
HHV 8
HBsAg
Surface antigen = current disease (or carrier)
Anti Hbs
Immune
Anti Hbc
Current or previous infection
HIV test method
ELISA
Western blot
Causes of false positive treponomal tests
Genital herpes
Psoriasis
RA
SLE
Egg vaccines
Flu, yellow fever
Live vaccines
MMR
Polio
Chicken pox
Yellow Fever
Typhoid
Von Willebrands Rx
DDAPV, TXA
Gauchers disease
Jewish
hepatosplenomegaly, anaemia, osteopaenia
Type I cryoglobulin
Waldenstroms
Type II cryoglobulin
Hep C, HIV
Type Iii cryoglobulin
Sjorgens
OD causing respiratory alkalosis
Aspirin, Theophyllines
Type I hypersensitivity
(Anaphylactic)
Anaphylaxis
Atopy
Drug Allergy
Type II hypersensitivity
(Cell Bound)
Goodpastures, anti GBM
MG
ITP
Tranfusion
Thyroid
Type III hypersensitivity
(Immune Complex)
post strep glom
Hep C B
HIV
Syspihilis, Shisto, SLE
Malaria
RA
Type IV hypersensitivity
(Cell mediated/delayed)
TB
Contact dermatitis
Graft rejection
Tumour
scabies
C1 Inhibitor deficiency
Hereditary angioedema
C2, C4 deficiency (classic pathway)
HSP
Glomerulonephritis
SLE
Strep
Staph
C3-C9 deficiency
Recurrent bacterial infection e.g Neisseria
Test for Type I Hypersensitivity
IgE/skin prick
Test for Type II Hypersensitivity
Coombs Test
Test for Type III Hypersensitivity
Antibody levels
Test for Type IV Hypersensitivity
Patch
Type I Hypersensitivity Ig
IgE
Type II Hypersensitivity Ig
IgG IgM
Type III Hypersensitivity Ig
IgG IgM
What type of hypersensitivity is urticaria?
Type I
What type of hypersensitivity is bullous disease?
Type II
What type of hypersensitivity is vasculitis?
Type III
What type of hypersensitivity is allergic contact dermatitis?
Type IV
Ataxic Telangoectasia syndrome
(inheritance, features, Ig)
autosomal recessive
kids - cerebellar ataxia, oculocutaneous telangiectasia, recurrent sinus/lung infections
Low IgA, IgE
Possible T cell deficiency
Wiskott Aldrich syndrome
X linked recessive
Eczema, thrombocytopaenia, recurrent infection
Lymph tumours
Low antibody, IgM high IgE
B and T cell
WASP
Raised IgG in liver disease
hepatitis, cryptogenic cirrhosis
Raised IgM in liver disease
biliary/alcoholic cirrhosis
Raised IgA in liver disease
alcoholic cirrhosis
Anti smooth muscle +ve
Hepatits
PBS
Cirrhosis
Viral infection
Anti mitochondrial +ve
PBC
Hepatitis
Cirroshsi
Gastric parietal cell antibody +ve
Pernicious anaemia
Atrophic gastrisi
Autoimmune thyroid disease
Thyroid autoantibodies
Hashimotos
Graves
Hypothyroidism
Pernicious Anaemia
ANA +ve
Sjorgens
Lupus
RA
MG
Hashimotos
UC
cANCA
Wegeners granulomatosis
Microscopic polangitis
pANCA
Idiopathic crescentic glomerulonephritis
Microscopic polyangitis
Churg Strauss
Hyperacute organ rejection presentation
Hours
Complemented mediated
Vascular spasm, occlusion, failed organ perfusion
Acute organ rejection
Days to weeks
HLA incompatibility
T cell/CD4
Chronic organ rejection
months-years
T Cells
What cells mediate graft versus host disease
T cells
Causes of +ve Coombs test
haemolytic anaemia/tranfusion reactions
LSE, lymphoma, leukaemia
Methyldopa
Loss of forearm pronation
Weak wrist flexion
Thenar wasting
Median nerve palsy
Wasting hand muscles, hypothenar
Claw hand
Radial deviation
Ulnar nerve
Paralysis of knee flexion
Foot drop
Ankle jerk and plantar reflex absent
Sciatic nerve palsy
What controls motor function
Basal ganglia
Anterior Cerebral Artery Occlusion
weak, numb contralateral leg
mild arm signs
face spare
Middle Cerebral Artery Occlusion
Contralateral hemiplegia
sensory loss face
dyphasia/dyspraxia
contralateral homonynmous hemianopia
Vertebrobasilar artery occlusion
Hemianopia
Cortical Blindness
Vertigo, nystagmus
hemi/quadraplegia
sensory loss, drop attacks, cerebellar sx
Lateral Medullary infarct = Posterior Inferior Cereberal Artery Infarct
vertigo, vomiting, nystagmus TOWARDS lesion
ipsilateral hypotonia
ataxia
horners
soft palate paralysis
Brocas dysphasia
Inferolateral frontal lobe
non fluent speech comprehension intact
Wernickes dysphasia
posterior superior temporal lobe
Fluent speech but errors
Issues reading, writing, comprehension
Fanconi syndrome
cystinuria, phosphaturia, RTA 2, glycosuria, rickets/osteomalacia
Cystinosis
cystine crystal deposition
RTA, Fanconi, renal failure, hepatosplenomegaly
RCT
Randomly allocated to intervention/control
Limited by ethics
Cohort study
Group of people exposed to something and then follow up to see how many develop disease/other outcome
Measured in relative risk
Case-control study
People with condition matched with control
Then data collected on past exposure
ODDS RATIO
Cross sectional study
Snapshot or prevalence
Not useful for cause/effect
Level of evidence: Ia
Meta analysis RCT
Level of evidence: Ib
At least one RCT
Level of evidence: IIa
At least one well designed control trial (not randomised)
Level of evidence: IIb
At least one well designed experimental
Level of evidence: III
case, correlation, comparative studies
Level of evidence: IV
panel of experts
Normal distribution
Mean = median = mode
Positively skewed distribution
mean > median > mode
Negatively skewed
mean < median< mode
Sensitivity
TP / (TP +FN)
tested +ve/who actually had it
Specificity
TN / (TN + FP)
tested -ve/ who actually didnt have it
Positive predictive value
(chance you have it if your test is positive)
TP / (TP + FP)
Had it and tested +ve/tested positive
Negative predictive value
(chance if you’re negative you didn’t have it)
TN / (TN +FN)
didnt have it and tested negative / everyone who tested negative
Likelihood ratio for positive test
sensitivity/ (1-specificity)
Likelihood ratio for negative test
(1 - sensitivity) / specificity
Relative risk
EER/CER
amount it occurs in experiment group/amount it occurs in control group
Penetrance
describes ‘how likely’ it is that a condition will develop
Expressivity
Severity of the phenotype
Odds
You do get the outcome/you don’t get the outcome
Odds ratio
Odds you do with x/ odds you do with placebo
Number needed to treat
1 / (EER -CER)
What % values lie within 1 SD of mean?
68.3%
What % values lie within 2 SD of mean?
95.4%
What % values lie within 3 SD of mean?
99.7%
Intention to treat analysis
Analysing random group of RCT patient regardless of whether they finished the treatment or not
Limits the effect of drop outs
Incidence
incidence is the number of new cases per population in a given time period.
For example, if condition X has caused 40 new cases over the past 12 months per 1,000 of the population the annual incidence is 0.04 or 4%.
Prevelance
Cases per population at any one time
Funnel plot
to show bias in meta analysis
treatment outcome vs study size vert
Standard error of mean
SEM = SD / square root (n)
Phase I Clinical Trial
pharmacokinetics and pharmacodynamics and side-effects prior to larger studies
Healthy volunteers
Phase II Clinical Trial
Efficacy and dosage
Small number affected by disease
IIA - dosing
IIb - efficacy
Phase III Clinical Trial
Assess effectiveness
Lots of people
RCT
Comparing new tx with old one
Phase IV Clinical Trial
Post marketing surveillance
Long term side effects and effectiveness
What does RER do?
translation/folding proteins
glycosylation
makes lyosomal enzymes
lots in pancreatic, goblet and plasma cells
What does SER do?
steroid and lipid synthesis
lots in adrenal, liver, testes, ovaries
What does Golgi apparatus do?
O-linked glycosylation
modifies, sorts, packages molecules meant for secretion
What does mitochondria do?
aerobic respiration
contains circular DNA
What does the nucleus do?
DNA maintenance
RNA transcription/splicing
What do lysosomes do?
Break down large molecules like proteins and polysacchrides
What does the nucleolus do?
Ribosome production
What does the peroxisome do?
Catabolism of v long chain fatty acids and amino acids, makes hydrogen peroxide
What does the ribosome do?
Translates RNA into proteins
What do proteasomes do?
Breaks down proteins
Anderson-Fabry disease
X linked recessive
deficiency of alpha galactosidase A
burning parathesia childhood
angiokeratomas
lens opacities
proteinuria
early CVD
Selection Bias
eg sampling biads, volunteer bias, non responder bias
Recall bias
People remembering things differently based on how they are now eg having lung ca and thinking you had asbestos
Publication bias
Not publishing things that aren’t as interesting etc
Work up/verification bias
Being reluctant to order gold standard when thats what youre comparing to
Expectation bias (pygmalion effect)
People reporting things based on what they think the study wants
Hawthorne effect bias
Knowing you’re being studied
Late-look bias
Getting info at inappropriate time eg years later when subject may have died
Procedure bias
People in same group get different treatment
Lead-time bias
New test diagnoses something arlier but doesn’t have any effect on the disease
Hazard ratio
For analysing survival over time
Type V Hypersensitivity
Graves disease
MG
What do Th1 Helper cells secrete?
Cell mediated immunity
IFN gamma IL2, IL3
What do Th2 helper cells secrete?
Humoural immunity
IgE
IL4, IL4, IL6, IL10, IL13
Nacrolepsy HLA
HLA DR2
Nicotinic Acetylcholine what type of Receptor
Ligand gated
Whats the usual outcome measure of a cohort study?
Relative risk
Fabry disease
Angiokeratomas “corneal whirl”
Proteinurias
Early MI/stroke
Shistocytes in blood smears
DIC
What type of receptor is ANP
Guanylate cyclase
Chi squared test
Comparing 2 percentages/proprotions
Mechanism of doxy
Inhibits 30s unit ribosomes
Achondroplasia mutation
FGFR3 fibroplast growth receptor
Achondroplasia inheritance
autosomal dominant
Features of achondroplasia
short arms and legs, short, flat nose
Bartters syndrome
Severe hypokalaemia defective chloride absorption Na+/K/Cl cotransporter loop of henle
Tay Sachs disease
lysosomal storage
cherry red spot macula
no hepatospelnomegaly
developmental delay
Mcardles disease
glycogen storage
myalgia
myoglobinuria
Homocystinuria features
fine, fair hair
Marfanoid
LD
downwards (inferonasal) dislocation of lens
VTE
also malar flush, livedo reticularis
Pathophysiology of homocystinuria
cystathionine beta synthase
Whats the definition of the p value?
is the probability of obtaining a result by chance at least as extreme as the one that was actually observed, assuming that the null hypothesis is true
DiGeorge Syndrome pathophysiology
Primary immunodeficiency
T cell dysfunction
DiGeorge Syndrome chromsome
Deletion 222 (22q11.2)
DiGeorge Syndrome features
viral/fungal infections
parathyroid gland hypoplasia → hypocalcaemic tetany
thymus hypoplasia
T-lymphocyte deficiency/dysfunction
Tetralogy of Fallot
VSD
RVH
right ventricular outflow tract obstruction, pulmonary stenosis
overriding aorta
Goodpasture HLA
HLA DRB1*15:01
Ank spond renal disease
AA amyloidosis - apple green +ve bifringence, enlarged kidneys, heavy proteinuria
IgA nephropathy
UC Vs Crohns
Transmural inflammation
Crohns
UC Vs Crohns
Fissuring ulcers
Crohns
UC Vs Crohns
Lymphoid/neutrophil aggregates
Crohns
UC Vs Crohns
Mucosa/submucosa only
UC
UC Vs Crohns
Crypt Abcesses
UC
UC Vs Crohns
Skip lesions
Crohns
UC Vs Crohns
Continous inflammation
UC
UC Vs Crohns
Transmural/all layers inflammation
Crohns
Few polyps and fhx of cancer
HNPCC
Loads of polyps (100s-1000s) and fhx of cancer
FAP
HIV nephropathy histology
Microcystictubular dilatation
Collapsing FSGS
CMV Tx
Gancliclovir
Which antibodies cross the placenta
IgG
Initial therapy for phaeochromocytoma SVT
Phenoxybenzamine
Philadelphia chromosome in ALL good/bad prognosis?
Bad
Weber syndrome
Midbrain stroke
THIRD NERVE PALSY SAME SIDE
Contralateral hemiparesis and hemiparkinsonism
Wallenberg syndrome
Lateral medullary syndrome
Ipsilateral pharyngeal/ palatal palsy
Ipsi horner syndrome
Ipsi pain/temp loss face
Contra pain/temp loss body
MOA/enzyme glitazone
CYP2C8
SVT in pregnancy tx
Beta blocker
Hyperlipoproteinaemia IB mutation
Apolipoprotein CII (APO CII)
Red spots with bluish white centre
Koplik spots
Measles
Sheep, lymphadenopathy
Fever
Sweats
Weight loss
Brucellosis
Tx for cholera
Doxy
Which immunoglobulins are responsible for haemolytic blood transfusion reactions?
IgM
Homocystinuria pathophysiology
deficiency of cystathionine beta synthase
Homocystinuria features
fine, fair hair
Marfanoid
LD
downwards (inferonasal) dislocation of lens
VTE
also malar flush, livedo reticularis
Homocystinuria tx
B6 supplementation
Conditions ax with turners
Cystic hygroma
Lymphedema
Hypothyroidism
Horseshoe kidney
Crohns
Features CF
short stature
diabetes mellitus
delayed puberty
rectal prolapse
nasal polyps
male infertility, female subfertility
Main constituent of pulmonary surfactant
dipalmitoyl phosphatidylcholine (DPPC)
Lesch-Nyhan syndrome
X recessive
juvenile gout
absence HGPRT
orange sand stools
Liddles syndrome
Hypokalaemia
HTN
Wilcoxon signed-rank test -
compares two sets of observations on a single sample eg before/after
DiGeorge Mnemonic
‘CATCH22
C - Cardiac abnormalities
A - Abnormal facies
T - Thymic aplasia
C - Cleft palate
H - Hypocalcaemia/ hypoparathyroidism
22 - Caused by chromosome 22 deletion
Kearns-Sayre syndrome
mitochondrial inheritance
onset < 20-years-old
external ophthalmoplegia
retinitis pigmentosa
Beckwith-Wiedemann syndrome
organomegaly, macroglossia,
abdominal wall defects, Wilm’s tumour neonatal hypoglycaemia.
Complement Leiner disease
C5
Norepinephrine receptor
G protein coupled receptor
Dermatitis herpetiformis HLA
HLA D3
Ligand gated ion receptors
Nicotinic acetylcholine
Gaba
glutamate
Tyrosine kinase receptors
insulin-like growth factor (IGF), epidermal growth factor (EGF)
PIGG(L)ET: Prolactin, Immunomodulators
GH, G-CSF,
Erythropoietin Thromobopoietin
Guanylate cyclase receptors
ANP/BNP
HLA Psoriasis
HLA CW6
T1 RTA
Anion gap
Normal
Lactic Acidosis Anion Gap
Raised
T1 RTA presentation
hyperchloraemic hypokalaemic metabollic acidosis
Linear IgG desposits
anti glomerular basement membrane disease
MOA sitagliptin
DPP-IV inhibitor
Tx cluster headaches
verapamil
Lip smacking seizure - which area of brain
Temporal lobe
CXR “mass surrounded by rim of air”
Aspergilloma
MODY presentation
diabetes without ketones
antibody negative
autosomal dominant
family hx
Latent Autoimmune Diabetes Adult LADA
Presentation
Treated as Type 2 for few years
High BMS
Ketonuria
Hx of auto immune
Warm AIHA features
Happens at body temp
Anaemia + jaundice +splenomegaly
Coombs test +ve
Cold AIHA features
Worse cold temp
Raynauds/purplish discoloration (acronyansosis)
Coombs test +ve
White turbid fluid joint
Acute Gouty Arthritis
1st step tx aortic dissection
Labetalol
Haemochromatosis inheritance
Autosomal recessive
Haemochromatosis pathophysiology
mutation of HFE on chromosome 6
C282Y (80%) AND H63D (20%) cause decreased hepcidin
Heinz bodies
GP6D deficiency
Howell Jolly bodie
Hyposplenism/splenctomy
Rouleax (blood film)
Waldenstroms, myeloma
Warm AIHA features
Happens at body temp
Anaemia + jaundice +splenomegaly
Cold AIHA features
Worse cold temp
Raynauds/purplish discoloration (acronyansosis)
Warm AIHA Ig
IgG
Cold AIHA Ig
IgM
What infections does Sickle Cell predispose to ?
encapsulated eg strep pneumoniae, salmonella
What organism causes aplastic sickle cell crisis?
Parvovirus
(Causes sudden drop in Hb)
“Pulmonary infiltrates” in sickle cell
Acute chest syndrome
Acute chest syndrome sickle cell presentation
SOB, chest pain, pulmonary infiltrates, hypoxia
Long term tx sickle cell
hydroxyurea
Carcinoid tumour features
tachycardia
flushing
bronchoconstriction
haemodynamic instability
diarrhoea
“lambda light chain” in kidney
myeloma amyloidosis
Tramline spine
Ank spond bamboo spine
Rugger Jersey spine
Renal osteodystrophy
Trophozites/cysts in stool culture
Giardia
Type II RTA
Hypokalaemic hyperchloraemic acidosis with low bicarb (high in urine) and high urine pH
Cisplatin side effects
Ototoxicity
nephrotoxicity - hypokal, mag, calc
Tx for Hep C
Daclatasvir, sofosbuvir +_ ribavirin
Ciclosporin mechanism
IL2 inhibitor
Small testes, delayed puberty, loss of smell
Klamanns syndrome
Retinal protein responsible for light perception
rhodopsin
Boney lumps DIP
Heberdens nodes OA
Boney lumps PIP
Bouchards node RA
Von Hippel Lindau
Cysts tumours everywhere
Chromosome 3
RCC common
Scheuermanns disease
irregular endplates
loss of disc space height
teenage girls
thoracic smooth lump
Hormone change at ovulation
LH surge
Net like rash
Cholesterol emboli
Sickle cell treatment
Hydroxyurea
McArdle disease
Repeated cramping and myoglubinuria (dark drown urine) after exercise
Illness where prophylaxis causing haemolytic anaemia
G6PD deficiency
Hypersegmented neutrophils
Megaloblastic anaemia
Left shift of myeloid cells
Pregnancy, severe infection, CML
Blast cells
AML/ALL
Auer rods
AML
Smear/smudge cells
lymphocytosis usually CLL
Primary thrombocytopaenia features
Bleeds/clots
splenic infarcts/atrophy
raised megakaryoctyes
Primary thrombocytopaenia tx
hydroxycarbamide, alpha interferon, anagrelide
aspirin
Polycythaemia rubra vera features
Clots - headaches, dizziness, VTE, stroke, hepatosplenomegaly
Tear drop poikilocytes
Myelobfibrosis
What condition often turns into myelofibrosis?
PRV
What condition does myleofibrosis often turn into?
AML
Most common leukaemia adults
AML
Philadelphia chromosome in ALL ?prognosis
Poor prognosis
CLL presentation
painless lymphadenopathy + anaemia
Smear cells
Reed Sternberg cells “owls eye” appearance
Hodgkins lymphoma
Most common type of Hodgkins
Nodular sclerosing
women
good prognosis
High number Reed Sternbergs ?Hodgkins type
Mixed cellularity
Best prognosis Hodgkins
Lymphocyte predominant
Worst prognosis Hodgkins
Lymphocyte depleted
Poor prognostic factors in AML
>60
>20% blasts after 1st chemo
deletion chromosome 5 or 7
Acute promyelocytic leukaemia genetics and cells
t15:17
fusion of PML and RAR alpha
Auer rods
“Increased granulocytes at different stages of maturation +- thrombocytosis”
CML
CML genetics
t9:22
q34:11
BCR-ACL
CML treatment
imatinib - tyrosine kinase inhibitors
Leukaemia presenting with DIC
APML
Good prognostic factors ALL
FAB L1 type
common ALL
Pre-B phenotype
low initial WCC
del 9p
Poor prognostic factors ALL
FAB L3 type
T or B cell markers
Philadelphia
<2 or 10<
male
CNS involvement
high WCC
not white
Hypodiploidy
“monoclonal proliferation well differentiated B lymphocytes”
CLL
Ann Arbor Stage I
single region lymph nodes
Ann Arbor Stage II
2 sites same side of diaphragm
Ann Arbor Stage III
several sites both sides of diaphragm
Ann Arbor Stage IV
extralymphatic structures
Tumour lysis syndrome
High phos, potassium, uric acid
Low Ca2+
Mantle cell lymphoma genetics
CD5+, CD19+, CD22+, CD23-, CD10-
t11:!4
Follicular lymphoma genetics
t 14:18
BCL 2
TTP antibody
ADAMTS 13
What clotting factor does Von Willebrand process
Factor VIII carrier protein
What factors doe Haemophilla A affect
Factor VIII
What factors doe Haemophilla B affect
IX
DIC blood features
prolonged PT, APTT, thrombin clotting
WCC, platelet, fibrinogen low
Chemo agent causing low Mg
cisplatin
Causes of intravascular haemolysis
Blood transfusion
G6PD
TTP
DIC
HUS
PNH
Cold AIHA
Causes of extravascular haemolysis
Sickle cell, thalasaemia
Hereditary sphereocytosis
Haemolytic of newborn
Warm AIHA
Haemophilia PT/APTT
PT normal
APPT prolonged
Antiphospholipid pregnancy tx
Aspirin and LMWH
Prognostic marker for myeloma
B2 microglobulin
MOA cisplatin
cross linking DNA
Haem issue causing headache, blurred vision
Waldenstroms
Causes warm AIHA
SLE
methyldopa
Causes cold AIHA
Mycoplasma, EBV
Surgical prophylaxis Von Willebrands
Desmo
Leukaemiod reaction (rather than leukaemia)
high leucocyte alkaline phosphatase score
Dohle bodies white cells
Left shit neutrophils
Von Williebrand PT/APTT
Mildly prolonged APTT
CLL poor prognostic markers
male
>70
lymphocyte >50
lymphocyte doubling <12 months
raised LDH
CD38
TP53
del 17
CLL good prognosis
del 13
Hereditary spherocytosis features
Fhx, gallstones, anaemia
splenomegaly FTT
EMA binding test
Glutide main side effects
Hypos
plus pancreatitis, renal imp, nausea and vomiting
Ca 125
Ovarian
Peritoneal
ECOG 0
Normal
ECOG 1
Can’t do strenuous stuff, but ok with work
ECOG 2
Ambulatory and ADLs but not capable of work
ECOG 3
Limited self care, confined to be more than 50% waking
Dapaglifozin SGLT2 risks
DKA
Increased cholesterol
Med to reduce risk of tumour lysis
rasbicurase
JAK 2
Thrombocythaemia
Sickle cell HbSC
Mild disease
Hereditary spherocytosis tx
Fluids, high dose folic acid
Diabetes meds contraindicated in CCF
Pioglitazone
G6PD triggers meds
primaquine
cipro
sulphs
Test for anaphylaxis post reaction
tryptase
Hodgkins poor prognostic markers
weight loss >10% 6 months
fever >38
night sweats
Acute intermittent porphyria enzyme defect
Uroporphyrinogen decarboxylase
Factor V Leiden mechanism
resistance to activated protein C
Common cancer tumour lysis syndrome
Burkitts lymphoma
Necrosis following warfarin
Protein C deficiency
What does polycythaemia vubra vera progress to?
Myelofibrosis, AML
Bilobed mononuclear cells
AML
Liver transplant criteria paracetamol OD
pH <7.3
or
INR >6.5 + grade 3/4 encephalopathy + Cr >300
Hypovolaemia shock post MI
RV infarct
Most common thyroid cancer
Papillary, great prognosis
Type and MOA pioglitazone, rosiglitazone
PPAR gamma agonist, increase insulin signalling/sensitivity
Conns triad
HTN + hypokalaemia + alkalosis
Conns causes
RAS
CAH
CCF
Corrhosis
Nephritic syndrome
Waterhouse Fredichsen
Septicaemia causing adrenal haemorrhage causing addisons
Primary hyperparathyroid
Tumour producing PTH
High PTH
HIgh Ca2
Secondary hyperparathyroid
Vit d deficiency
Low/normal ca
High PTH
Tertiary hyperparathyroidism
Secondary hyperparathyroidism goes on for ages causing high PTH, causing high Ca2
Hyperaemic membranes
TSS
Where do SGLT 2 inhibitors glifozins work
Early PCT
Glutide main side effects
Hypos
Indications for surgery in HPTH
<50
CA >0.25 upper lmit
eGFR <60
renal stones/nephrocalcinosis
osteoporosis
sx
Mst common cause primary hyperaldoteronism
Adreanl hyperplasia
Pendred syndrome
Deafness and hypothyroid
MOA gliptins
DPP 4 inhibitors
Dapaglifozin SGLT2 MOA
Stops reabsorption glucose proximal renal tubule
Dapaglifozin SGLT2 risks
DKA
Normal fasting glucose
<6.1
Post glucose /random glucose
<7.8
Kallmans syndrome
Like kleinfelters but low LH, FSH and crypto orchidism
Sulfonylureas MOA
increase insulin secretion B cells and decrease hepatic clearance
MODY 3
most common
ax with HNF alpha
inc risk HCC
MODY 2 gene
glucokinase
MODY 5
rare
cysts
HNF 1 beta
Gitelmans syndrome
Defect in Na Cl transporter DCT
Normotension
Hypokalaemia
Hypocalciruia
Hypomagnesaemia
Met alk
Target HbA1c T1DM
48
Estrogen only HRT risk
Endometrial ca
Supressed by high but low dose dex suppresion test
Cushings disease
Diabetic meds that dont cause hypos
Metformin
Glitazones
Gliptins
Diabetic meds that do cause hypos
Gliclazides
Exanatides
Type and MOA gliclazide, glimperide
Sulfonylureas, inhibit K ATPase
Type and MOA exanatide, lirglutide
GLP 1
stimulates GLP1 receptor, Ca2+ influx, inc insulin
Type and MOA sitagliptin, linagliptin
DDP4 inhibitors
Stops breakdown of GLP1
Type and MOA pioglitazone, rosiglitazone
PPAR, increase insulin signalling/sensitivity
Type and MOA empagliflozin, dapagliflozin
SGLT 2 inhibitors
inhibit kidney reabsorption of glucose, excretes more in urine
Type and MOA acarbose
alpha glucosidase inhibitor
inhibits gut absorption of glucose
What are insulin stress tests used for
Cushings vs pseudo cushings
Addisons electrolyes/ph
Low Na
High K
Acidotic
Hookworm presentation
itchy rash then resp asthma/allergy sx, the GI upset +- anaemia
India
Pseudohypoparathyroidism bloods
PTH: high
calcium: low
phosphate: high
Pseudohypoparathyroidism features
short fourth and fifth metacarpals
short stature
cognitive impairment
obesity
round face
Pseudohypoparathyroidism genetics
G protein mutation
auto dom
Well done!
.
Impaired glucose tolerance
7.8-11.1
How to test for Zollinger Ellison
Serum gastrin
Ocreotide scan
Impaired fasting glucose
6.1-7
Impaired glucose tolerance
7.8-11.1
Tx Listeria meningitis
aciclovir, cef, ampicillin
Painless solitary genital ulcer
Syphillis
Painless genital ulcer painful lymphadenopathy
Lymphogranuloma verenum
Painful ulcer Painful lymphadenopathy
Chancroid (Haemophilis ducrei)
What does ezetimibe do
redcues intestinal cholesterol absoprtion
CSF TB Meningitis
very low glucose
Enterovirus meningitis
cold, diarrhoea preceding
resp/faeco-oral spread
creche
Necrotising pneumonia
predeing viral illness
empyema/abcess
Staph aureus
Adult Stills Disease
Fluctuating salmon Pink rash
Arhtralgia
Hepatosplenomegaly
Fever
Azothiaprine eznyme
TPMT thiopurine methyltranferase
Intracranial bleed with cranial nerves, hyponatraemia, hypokalaemia
Pituitary apoplexy
Cholestrymine on INR
Lower
Abx worsening SE of statin
clarithromycin
SHBG in PCOS
Low
Intoxicated, high BP, high HR, low K+
amphetamines
Muscle weakness in medial epicondylitis/ulnar nerve palsy
adductor pollicis
Hookworm presentation
Rash then resp asthma/allergy sx, the GI upset +- anaemia
India
definitive test myotonic dystrophy
Genetic testing
APML tx
all trans retinotic acid ATRA
Reasons to stop stress test
>250/115
2mm ST depression lateral leads
What age to continue HRT to in early menopause
51
Exogenous insulin on C peptide
supresses
How to test for Zollinger Ellison
Serum gastrin
Tx for chlamydia pneumonia
Erythromycin
physiological pred dose for 75kg man
7.5mg
1st line tx OCD
CBT, ERP
Thrombolysis window stroke
4.5 hours
Vitamin supplement in CF
Vitamin A
Hormone pattern PCOS
High LH, normal FSH, normal estradiol, high testosterone
Right sided stroke, DVT ?cause
PFO
Choroid neovascularisation
Dye stain leaking at macula
?diagnosis
Age related macular degeneration
Tx anti VEGF
SE/caution of tevinor/truvada (HIV med)
renal impairment
Painless transient visual loss
Curtain descending
?diagnosis
amaurosis fugax
Amaurosis fugax tx
Clopidogrel
Ulcers ax with RA
Pyoderma gangrenosum
Photosensitive blistering rash
Ax with alcohol, HIV, hep, estrogen
Porphyrea cutanea tarda
Intestinal Bacterial Overgrowth
E coli/bacteroides
Presents diarrhoea, B12 deficiency
tx with metro
Prolactinoma medical management
Cabergoline (dopamine agonist)
Which anti malarials are contra indicated in epilepsy
mefloquine
chloroquine
Malaria prophylaxis in pregnancy
chloroquine
folate supplements
TV definition
volume inspired or expired with each breath at rest
Inspiratory reserve volume 2-3 L Definition
maximum volume of air that can be inspired at the end of a normal tidal inspiration
inspiratory capacity = TV + IRV
Expiratory reserve volume (ERV) = 750ml
maximum volume of air that can be expired at the end of a normal tidal expiration
Residual volume (RV) = 1.2L
volume of air remaining after maximal expiration
Functional residual capacity (FRC)
the volume in the lungs at the end-expiratory position
Vital capacity (VC) = 5L
maximum volume of air that can be expired after a maximal inspiration
Total lung capacity (TLC)
sum of the vital capacity + residual volume
Physiological dead space (VD)
VD = tidal volume * (PaCO2 - PeCO2) / PaCO2
Causes of raised transfer factor
Asthma
Pulmonary haemorrhage
Weg/goodp
L to R shunt
polycythaemia
hyperkinetic
male
exercise
age
Causes of low TLCO
Pulmonary fiborsis
pneumonoa
PE
pulmonary edema
emphysema
anaemia
Low cardiac output
Primary Sclerosing cholangitis features
Cholestatis
pANCA
male
jaundice, pruritis, fatigue
PMR symptoms
raised ESR, CRP
Weight loss/anorexia
Normal CK
Anastrazole mechanism
blocks peripheral tissue conversion of androgen to estrogen
Pneumonectomy eligibility criteria
FEV >2L
FEV >50% of FVC
Normal PaC02 at rest
When do you use CEA for colorectal ca
post op surveilance
Rhomboid shaped crystals on joint aspiration
pseudogout - pyrophosphate arthritis/chondrocalcinosis
Rash “concentric rings varying colours”
Erythema multiforme
Hep E endemic region
North Africa
Trauma -> muscle wasting of whole hand
T1 nerve root damage
Other antibodies ax with anti phospholipid
anti b2 glycoprotein
anti cardiolipin
Dig toxicity
Complete heart block
Nausea/vom
Yellow vision
Brady/hypo
Complete heart block post MI ?which vessel
Posterior interventricular artery
1st line for acne and hirstutism in PCOS
Dianette Co-cyprindol
What causes in renal impairment in rhadomyolysis
Myoglobin
Botulin vs tetanus
Tetanus is rigid paralysis, botulin is flaccid
VTE and nephrotic syndrome
Anti thrombin III deficiency
PPAR drugs
fenofibrate
Immunoglobulin well person, allergic reaction blood
IgA
Familial primary pulmonary HTN sx
SOB, faitgue, angina
raised JVP
Left parasternal heave
pansystolic mrumur
S4
peripheral edema
Acanthosis nigricans ax illness
gastric adenocarcinoma, endometrial carcinoma
Cyanotic but not hypoxic
methaemoglobinaemia
sulfonamide exposure
tx methylene blue
Pneumonia:
Young person
out of keeping radiology
muscle ache
cold agglutins
Mycoplasma
Pontine haemorrhage stroke ?Vessel
Basilar artery
Malignant otitis externa
Otitis externa spreading to temporal bone/skull
Facial nerve involvement
Caused by pseudomonas aeruginosa
Trigeminal neuralgia sx with sensory loss
Tumour
Tx for recurrent renal stones with hypercalciruia
Thiazide diruetic
Indications for pacemaker
persistent symptomatic bradycardia
Trifasicular block
mobitz type 2 AV block
sinus pause >3s
Anterior MI v1-v6
LAD
Septal M1 V1-V4
LAD septal branches
Lateral MI I, aVL, V5, V6
Left circumflex
Inferior MI II, III aVF
Right coronary artery (80%) or Right circumflex (20%)
Posterior MI V7, V8, V9
RCA
Right ventricle MI VI, V4R
RCA
Thoracic Outlet Syndrome
Pulse disappears when arm raised above head
pain, parathesia, numb arm
Ix doppler
Lipaemic sample pancreatitis
Triglycerides/chylomicrons
Power of study definition
probability of rejecting null hypothesis when its false
Cancer PSC progresses to
cholangiocarcinoma
Digital ischaemia tx
phentolamine
Gabapentin mechanism
binds to alpha 2 delta on voltage gated calcium
Skin plaques and acid fast bacilli
Leprosy
Pramaquine MOA
Removes hypnozites from liver
Somatostatin effect
Reduces gastrin secretion
Reduces gastric motility
Modified glasgow pancreatitis criteria
Age
O2
WCC
Ca
ALT
LDH
Glucose
Urea
Albumin
2nd line for animal bite
doxy and metro
T2DM med to avoid in gastroparesis
GLPT 1 glutides
Visual change with benign ICH
Enlarged blind spot
Constriction visual field
Yellow fever
Flavivirus
flu, epigastric pain, bruising, bleeding gums, fever
Doxasoin SE
worsens CCF
peripheral edema
palpitations
Pseudohypoparathryoidism mechanism
loss of function G protein linked to PTH receptor
Sx constrictive pericarditis
Raised JVP steep Y descent
pusatile liver
Right heart failure
Kidney disease ax with syphilis
Rapidly porgressive glomerulonephritis
Worst alpha 1 anti trypsin phenotype
PIZZ
Best alpha 1 anti trypsin phenotype
PISS
CYsticerosis
tapeworm
lump + seizure
Headache better lying flat
Intracranial hypotension
Tx PHT with multi focal atrial tachcardia
verapamil
MOA propylthiouracil
inhibits conversion thyroxine to tri iodothyonine
Acute pain
Small irregular oval pupil
photophobia
red eye, lacrimation
CILLARY FLUSH, hypopyon
Anterior uveitis
Anterior uveitis tx
atropine, cyclopentolate
steroid eye drops
Hutchinsons sign
HZO
Rash on tip or side of nose
nasocillary involvement, strong risk factor ocular involvement
HZO tx
PO anti virals 7-10 days
can use topical steroids for any inflammation
Severe pain
Decreased visual acuity
semi dilated pupil
Hazy cornea, halos
Acute angle closure glaucoma
Acute onset
pain
blurred vision photophobia
small, fixed, oval pupil, ciliary flush
Anterior uveitis
Visual loss following surgery
Red eye
pain
Endopthalmitis
Pathophysiology thyroid eye disease
glycosaminoglycan and collagen deposition in the muscles
Management thyroid eye disease
Lubricants
Steroids
radiotherapy
surgery
Red flags thyroid eye disease
deterioration in vision
change in color
eye pops out
corneal opacity
cornea visible when eyes closed
disc swelling
Bilateral
gritty/discomfort
sticky eyes in morning
red eyelid margins
+- swollen eyelids, styles, chalazions
Blepharitis
Blepharitis tx
Hot compress
Lid hygiene
artificial tears
Reduced vision
faded colour
glare
halos
defect in red reflex
Cataracts
Cataracts risk factors
smoking, DM, alcohol, trauma
long term steroids
radiation
myotonic dystrophy
hypocalcaemia
Complications of cataract surgery
posterior capsule opacification
retinal detachment
endophthalmitis
Keratitis organisms
bacterial - staph a, pseudomonas aeruginosa contact lens
funga
amoebic keratitis (soil/contaminated water)
parasitic onchocercal river blindness
HSV
exposure
Red eye
photophobia
foreign body/gritty
hypopyon
Keratitis
Management keratitis
topical abx
cycloplegic for pain
Complications of keratitis
corneal scarring
perforation
endopthlamitis
visual loss
Redness/swelling
severe ocular pain
visual disturbance
proptosis
pain/opthalmoplegia on eye movements
eyelid edema/ptosis
Orbital cellulitis
Orbital cellulitis vs preseptal cellulitis
reduced visual acuity, proptosis, pain/opthalmoplegia on eye movements = orbital cellulitis
Floaters
Flashers
blurred vision
Cobwebs across vision
dark curtin descending
Weiss ring
Posterior vitreous detachment
Posterior vitreous detachment tx
should self resolve
if retina tear will need treatment
Risk factors for vitreous detachment
Age
Myopia
Cupping of disc
glaucoma
Tx glaucoma
prostaglandin analogue eye drops
2nd line beta blocker, carbonic anhydrase / sympathomimetic
Prostaglandin analogue eye drops
increases uveoscleral outflow
brown pigmentation eye, increases eye lash length
Beta block eye drops
avoid in asthmatics or heart block
Sympathomimetics e.g brimonidine
Reduces aqueous production and increased outflow
Avoid if taking MAOI or TCA, causes hyperaemia
Carbonic anhydrase inhibitor eyedrops eg Dorzolamide
Reduces aqueous production, sulphonamide like reactions
Miotic eye drops e.g pilocarpine
increase outflow
SE constricted pupil, headache, blurred vision
Dry macular degeneration
90% of all
Drusen spots - yellow spots in bruchs membrane
Wet macular degeneration
choroidal neovascularisation
eudative
worst prognosis
ARMD sx
decreased visual acuity (near)
poor dark vision
fluctuating visual disturbance
photopsia/glare
distortion of ines Amsler grid
red patches/drusen spots
Supplements for dry ARMD
Vit A, C, E and zinc
no beta carotene for smokers
Angioid retinal streaks
dark red streaks on fundoscopy
caused by breaks in bruchs membrane
ax pseudoxanthoma elasticum, ehler danlos, pagets, sickle cell, acromegaly
“plucked chicken” skin
psuedoxanthoma elasticum
Treatment of acute glaucoma
acetazolamide + pilocarpine
What is a Holmes Adie pupil
Dilated and slow to react pupil
little/no response to light
absent/poor tendon reflexes
“Pale well demarcated disc” on fundoscopy
Optic atrophy
Acquired causes optic atrophy
MS
Papilloedema
raised IOP
Retinal damage
ischaemia
toxins
nutrition B1, B2, B6 , B12
Cogenital causes optic atrophy
Friedreich ataxia
Mitochondrial disorders
DIDMOAD (DI, DM optic neuropathy, deafness)
Most common RA eye disease
keratoconjunctivitis sicca
RA red eye painless no itch
episcleritis
RA dry, itchy
sicca
RA red painful eye
scleritis
Causes of tunnel vision
papilloedema
glaucoma
retinitis pigmentosa
choroidoretinitis
optic atrophy
hysteria
Argyll Robertson pupil
accommodate but dont react
tertiary syphilis
HZO tx
PO aciclovir
Ramsay hunt
HVV FACIAL nerve (HZO is TRIGEMINAL)
Sudden loss of vision + severe retinal haemorrhages on fundoscopy
Central Retinal Vein Occlusion
Cherry red spot on pale retina
Central retinal artery occlusion
Night blindness + tunnel vision
Retinitis pigmentosa
Confusion and papilloedema
Vit A toxicity
Causes of RAPD
Retina detachment
Optic neuritis
MS
RAPD (Marcus gunn)
light shone into affected eye both eyes dilate
Kidney disease ax retinitis pigmentosa
Alports syndrome
Visual loss - dense shadow starting peripherally moving inwards
Retinal detachment
Enlarging dark spots in vision
Vitreous haemorrhage
Stage I hypertensive retinopathy
Arteriolar narrowing, tortusoity
Increased light reflex, silver wiring
Stage II hypertensive retinopathy
AV nipping
Stage III hypertensive retinopathy
Cotton wool eudates
Flame blots haemorrhages
Stage IV hypertensive retinopathy
Papilloedema
Mild NPDR
1 or more microaneurysm
Moderate NPDR
Microaneurysms
blot haemorrhage
hard excudates
cotton wool spots
venous beading/lopping
Severe NPDR
blot haemorrhages and microaneurysms 4 quadrants
venous beading 2 quadrants
IRMA 1 quad
Diabetic Proliferative retinopathy
neovascularisation
fibrous tissue ant to disc
Diabetic Maculopathy
hard exudates
Friedrichs ataxia
cerebellar sx
L and UMN
pes cavus
normal IQ
optic atrophy pale disc
intracranial bleed causing fluctuating confusion over time
subdural
Tx neuroleptic malignant sydrome
dantrolene
Cancers ax with von hippel lindau
clear cell renal
hemangiomas
PD vs drug induced parkinsons
PD = rigid, resting tremor DIP = bilateral sx
Huntingtons genetics
trinucloetide repeat CAG
auto dom
MS tx
beta inteferon
GBS paralysis
flaccid
hyporefflexia, tachycardia
Miller Fisher syndrome
areflexia, ataxia opthalmoplegia
variant of GBS
NF1
Cafe au lait
Axillary/groin freckles
Peripheral neurofibromas
Lisch nodules
scolisos
phaeochromcytoma
NF2
Bilateral vestibular schwannomas
meningomas
ependynomas
intracranial schawnommas
Tuberous sclerosis
Ash leaf spots
adenoma sebaceum
shagreen patches
subungal fibroms
epilepsy
develpmental delay
retinal haematomas
Migraine acute tx
triptan
Migraine prophylaxis
tompiramate, propanolol
Tx for drug induced PD
benzhexol
“slow relaxing grip”
myotonic dystrophy
Loss of corneal reflex
acoustic neuroma
Dementia and myoclonus
CJD
Autonomic dysfunction +PD/cerebellar signs
multi systems atrophy
Long term prophylaxis cluster headaches
Verapamil
Patchy haemoorahgic change on MRI Head
HSV encephalitis
Thrombectomy window
6 hours
Intracranial bleed - hypodense not confied to suture lines
chronic subdural
Epsilon sign
Right ventricular dysplasia
Test for acute Hep C
HCV RNA
Kussmaul sign
insp inc venous pressure, steep y jvp - perocarditis
tx broad beta
fibrate
NMS vs serotonin
serotonin = myoclonus, hyperreflexic, tremor NMS = rigid
loose bodies in joint
osteochondritis dissecans
onion peel bone
ewings sarcoma
Thailand
Subcut nodule pus
gram neg bacellie
meliodosis
Main clinicl sign of left ventircular dysfunction
4th heart sound
amitriptyline OD with VT tx
bicarb
Bone mets with breast ca pain relief
Bisphosphonates
Raised ALP, cortical thickening, trabceular pattern
Pagets
PD tx
interfering - levodopa
not intefering - dopamine receptor agonist eg ropinrole
Test for 2 catgeories eg men/women
1 sample proprotion test
Test for 2 categorical variables eg child/adult, man/woman
chi squared
Test for numeric value eg height
T test
Test for 1 numeric and 1 categorical eg height men/women
T-test/ANOVA
Test for 2 numerical values eg height/weight
Corelation test
What level of evidence is RCT
Ib
Test to compare 2 percentages
Chi squared
Testing for correlation between two variables eg is there correlation between height and FVC
Linear regression
Spearman ranked
Paired v unpaired T test
Paired = same group of people before/after
Unpaired - 2 groups of people
Parametric tests
Students t
Pearson product-moment
Ascending cholangitis
Charcot triad - jaundice, RUQ, Fever
Gallstones
E coli
Ascending cholangtiis vs cholecystitis
Cholan - charcot triad
chole - murphys
Diethylene glycol tox/OD tx
IV ethanol
haemodialysis
Tropical med, non specific sx, eosinophilia
helminth/hookworm
Biventricular hypertrophy on ECG
VSD
What type of renal disease is Churg strauss and wegeners
focal segmental glomerulonephritis
MRI: increased signal in pulvinar of thalamus
CJD
Hyperoxaluria/uric oxalate renal stones tx
calcium supplemements
Impaired memory/planning
inappropriate behaviour
diminishing speech
fronto temporal dementia
Etanacerpt
anti TNF alpha
CI in MS. TB
MS CF
oligoclonal bans
raised IgG
TB drug course length
TB meningitis 12 months
everything else 6 months
Signet ring cells
adenocarcinoma
MOA bupropion
Noradrenaline dopamine reuptake inhibitor
Topiramate side effects
weight loss, renal stones, behaviour change
Amiodarone induced thyrotoxicosis tx
Anti thyroid drug and cortico steroids
mechanism of pedal edema in ccf
increased renin
Bronchial carcinoma tumour marker
Chromogranin A
Recurrent infections
spanish
immunoglobuin deficiency
IgD deficiency
Kearn sayre syndrome
sensineural hearing loss
mitochondrial
atazia
stroke
retinitis pgimentose
cardiomypathy
diabetes
Usher syndrome
retinitis pigmentose, hearing loss
What des BCR ABL code for
tyrosine kinase
Meds causing torticollis or acute dystonia
Prochloperazine, metocloperamide
Nerve root - weakness of thumb, numbness first web space
Radial nerve
NMS tx
dantrolene
Tx paraneoplastic pemphigous
steroids
SE carbimazole
rash
pruritis
arthalgia
alopecia
agranucytosis
jaundice
Lyme disease test
Borrelia IgG
Irregular plauqe like lesion
chronic progressive
indurated
foreign
Lupus vulgaris
Annular rimmed lesion with punched out hypopigmented centre
Borderline leprosy
Gold standard bronchiectasis diagnosis
HRCT
ECGs sign of impending cardiac arrest hyperkalaemia
prolonged QRS
Tx Neisseria mengitis
Ceftriaxone
RF Ig?
IgM
Why do people with CLL need irradiated blood?
Depletion of donor white cells
Where does 4th heart sounds sit on ECG
After P wave
Night sweats, lethargy, penumonia sx, hypercalcaemia
pulmonary sarcoid
Tx for lupus
hydroxchloroquine
life threatening: cyclophosphamide
lupus nephritis: mycophenolate mofteil
Tx necrobiosis lipoidica
Topical corticosteroids
Goes into VT whilst pacemaker - where had been touched?
coronary sinus
Tx Whipples disease
IV cef
mucosa appeared yellowed externally with erythematous erosions
Whipples
Dx ank spond if active sx
MRI sacro iliac
Pericarditis ECG
Saddle shaped ST most leads
Bone issue:
High ALP
low phos
Lowish Ca
High PTH
Osteomalacia
Pagets disease bloods
isolated ALP rise
Docetaxel renal impairment toxicity
renal tubular toxicity
MOZ tocilizumab
Anti IL 6
Tx for nephrogenic DI
hydrochlorthiazide
MOA baclofen
GABA agonist
Antibodies causing neonatal heart block
Anti RO, anti La
Tx syphilis
penicillin, doxy, azithro
Diabetic med good for heart failure/ CV health
dapagliflozin
SE pyrazinamide
joint pain
hepatitis
fever
SE rifampicin
thrombocytopaenia, nausea, vom
Cahnce of sibling being a HLA match
25%
Best anti hypertensives if on lithium
Ca channel blockers
2st step DKA tx
fluids
Scale for assessing ALDs
Barthel
Muscle causing fixed flexion deformity
rectus femoris
Virus causing anal cancer
HPV
Tx for Crohns skin/stoma ulcers
SC infliximab
Eplenerone site kidney
Distal PCT
1st line tx urgent thryoid eye disease
IV methylpred
Toxin causing heptaocellular carcinoma
aflatoxin
Positive urine nitroprusside
hexagon shaped crystals on urine analysis
cystine stones
Boil breaking down to large painful ulcers
pyoderma gangrenosum
Mechanisms of haemolysis in G6PD
Reduced NADPH
When is 3rd nerve palsy likely compressive
pupil inovolvement
Porphyrias skin AND abdo
variegate porphyria
How long after increasing phenytoin should you check levels
2 weeks
MOA etanercept
TNF alpha
headache, fever myalgia, rash with black centre
mediterrean spotted fever
Can’t sit still
Akthasia
Chiari 1
herniation of cerellbar tonsils
older
Chiari 2
Arnold chiari
happens when younger
Antidote to beta blocker overdose
IV glucagon
dehydration, sthen seizure, then focal neurology
saggital sinus thrombosis
Study type that has biggest issue with recall bias
case-control
Palm/sole melanoma
acral lentigous
Sun exposed area melanoma
Lentigo maligna
Which polyarteritis isnt ANCA +ve
polyarteritis nodosa
Tropical med + raised Right hemidiaphragmm
amoebic liver abcess
Life threatening warfarin bleed tx
Prothrmobin complex and vit K
Renal disease caused by NSAID
Interstitial nephritis
Pneumonia causing haemolytic anaemia
Mycoplasma
