Part 2 Flashcards
Brucellosis tx
Doxy and rifampicin 6 weeks
Wellens syndrome ECG
T wave inversion or biphasic T waves V2-V3
Wellens syndrome significance
Critical LAD stenosis
Wellens syndrome treatment
Tx as STEMI
Scleroderma renal crisis tx
ACEi Dialysis/transplant
Bleeding with prolonged APPT
VWD
Drug to bring out Brugada ECG changes
Flecanide
Whipples disease features
*Diarrhoea* *Arthralgia* Neuro sx Skin pigmentation/photosensitivity Middle aged men
Chest pain <48hr after MI
Pericarditis
Diarrhoea + low B12 + high folate
SBBO
Temp post Blood transfusion (TRALI or TACO)
TRALI
Blood products more commonly causing TRALI
FFP/platelets
What is Plummer Vinson syndrome
Esophageal webs Dysphagia IDA
Liver cirrhosis + previously lived abroad
Schistosomiasis
Tx for HUS
Supportive Plasma exchange Ecuzilumab
What is Nijmegen questionnaire for?
hyperventilation syndrome
How to adjust NIV to get rid of more CO2?
Increase IPAP
How to adjust NIV to improve oxygenaton?
Increase EPAP or 02
What is carcinoid syndrome
Tumour secreting serotonin
Features of carcinoid syndrome
Valve disease (P or T) Right sided heart failure Chronic diarrhoea Flushing Hypotension
Ix for carcinoid syndrome
urinary 5-HIAA plasma chromogranin A y
Tx for HTN in pregnancy
labetalol
Fasting BM of >7 in pregnancy management
Insulin Aspirin
Esinophilia - Churg Strauss or Wegners?
Churg Strauss - esinophilia with polyangitis
TB drug causing arthalgia
Pyrazinamide
MI + CCF - what drugs do you need to be on?
ACEi beta blocker statin mineralocorticoid receptor antagonist (e.g. eplenerone)
Kleinfelters + can’t smell
Kallmans
Anaemia and gallstones =?condition
Hereditary spherocytosis
Tx Q fever
Doxycycline
Farmer, fever, transamenitis
Q fever
Tx botulism
Trivalent antitoxin
Muscle weakness “Endomysial lymphocytic infiltrates that invade nonnecrotic muscle fibres”
Polymyositis
Muscle weakness “Perimysial inflammation of lymphocytes and parafascicular atrophy “
Dermatomyositis
Lupus + loin pain + haematuria
Renal vein thrombosis
Drugs causing DRESS syndrome
Anti epileptics Allopurinol Chemo
Features of DRESS syndrome
(Drug Reaction With Esinophilia and Systemic Symptoms)
Widespread rash
Fever
High lymphocytes
Esinophils
Malignant MCA syndrome
Young people have MCA infarct then bleed out, get raised ICP, drop GCS, need craniotomy
How do you calculate anion gap?
Sodium - (bicarb + chloride)
Normal anion gap
8-12
Poisoning causing acidosis and raised anion gap
glycols methanol oxoproline lactate ketones aspirin,
Ix to diagnose MG?
Single fibre EMG
Dementia with fluctuating cognition
Lewy Body
1st line tx RA
Methotrexate and pred
Cluster headache frequency, duration
1 every other day - 8x day last 15-180 minutes
Paroxysmal hemicrania
>5x/day respond absolutely to indomethacin
Hemicrania continua
continuous headache like cluster but never lets but responds to indomethacin
How to reduce eye complications in methanol poisoning
Folinic acid
HIV neuro symptoms headache CSF India ink positive
Cryptococcal meningitis
Tx for cryptococcal meningitis
amphotericin B & flucytosine
Non caseating granulomas (on bronch)
Sarcoid
Africa + itchy skin + asthma
strongyloides
Strongyloides tx
Ivermeticin
Ank spond features (As)
Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis
POEMS syndrome
paraneoplastic polyneuropathy, organomegaly, endocrinopathy, M-protein band from a plasmocytoma, and skin pigmentation
Young people presenting with PVD symptoms but no vascular risk factors, possibly affecting upper limbs
Thrombophlebitis obliterans
“yellow-green colour under Woods lamp”
Pityriasis versicolour
Valproate + high ammonia + impaired GCS
valproate-associated hyperammonaemic encephalopathy (VHE)
Homozygous FH presentation age
<30
Heterozygous FH presentation age
>30
Jarisch-Herxheimer reaction
syphilis - get fever, rash and tachycardia after B abX started
How to diagnose DeQuervains thyroidits
thyroid scintigraphy globally reduced uptake of iodine-131
1st line treatment for T2DM w new HTN (regardless of age or race)
ACEi
Monitoring for primary hyperparathyroidism
DEXA 1-2 years U+Es Ca2+
Angiod retinal streaks
Ehler Danos
Aquaporin-4 +ve
Neuromyelitis optica
Polymorphic eruption of pregnancy vs Pemphigoid gestationis
PEP - last trimester PG blisters, often starts around umbilicus
Limbic Encephalitis antibody
NMDA
Test for SBBO
jejeunal aspirate
Councilman antibodies
Yellow fever
Features of severe malaria
hypoglycaemia acidosis coma convulsions severe anaemia pulmonary oedema
When to Ix anaemia in dialysis
Hb <110 or sx of anaemia
Blood test for auto immune pancreatitis
IgG4
Tx for high output stoma not responding to loperamide
Ocreotide
Antibodies for MG
Anti ACh Anti MUSK
Cause of low TSH and low T4 (secondary hypothyroidism)
Pituitary failure
How to diagnose acromegaly
Oral glucose tolerance test, IGF, growth hormone
Anti epileptic to avoid in absence seizures and juvenile epilepsy
Carbemazepine
Medication for cystine renal stones
D pencillamine
HIV med causing psychosis in toxicity
Efavirenz
Spirometry measurement for GBS
FVC
Medication prophylaxis for altitude sickness
Acetozolamide
What type of RTA is nephrocalcinosis
1
Migraine prophylaxis for child bearing
Propanolol
Definition of bisphosphonate failure
two or more fractures on treatment, or one fracture with a reduction in bone density
Treatment of hyperthyroidism in pregnancy
Propilthyrourcil in early pregnancy
Carbimazole in late pregnancy
Hypokalaemia + low urine calcium
Gittlemans
Missipissi
Histoplasmosis
Prolonged high aldosterone on standing
Adrenal hyperplasia
PD meds causing loss of control/impulse disorders
Pamiprexole
Tx for peritonitis from dialysis
intraperitoneal vanc and gent
Goodpastures treatment
Pred, cyclophosphamide, plasmapheresis
Dextrocardia ECG findings
inverted P wave in lead I, right axis deviation, and loss of R wave progression
R waves in V1-2 MI location
posterior
Tx prosethtic valve replacement IE
IV vancomycin + rifampicin + low-dose gentamicin
Most common cause of canon ball mets
Renal cell carcinoma
Acute 3rd nerve palsy
Posterior communicating artery aneurysm
ABx you cant give with methotrexate
Trimethoprim/ Co-trimoxazole
Ferritin target in CKD
>200
Malodorous sweat infection
Brucellosis
Tx for VTE if 7 days pre op
IVC filter and LMWH
Hypokalaemia + renal stones
RTA 1
Baseline test before starting natalizumab
JCV antibody (otherwise can cause progressive multifocal leukoencephalopathy)
Anaemia, weight loss, lymphadenopathy post transplant
EBV
Antibody test for drug induced lupus
Anti histone antibodies
Heinz bodies
GP6D
Underlying condition/deficiency leading to warfarin induced necrosis
Protein C deficiency
Vitamin D <30
loading dose
Vitamin 30-50
maintenance dose
Osteomalacia + Hypokalaemia = RTA?
RTA 2
Tx for prognosis pulmonary fibrosis
carbon monoxide transfer factor
Auer Rods
Acute Promyelitic Leukaemia
Leopard print rash
Oncheriasis
Tx crusted scabies
Ivermectin
Monitoring for acromegaly tx
Insulin like growth factor
Meds to avoid with cocaine
beta blockers
No vaccinations + fever + rash + pancytopaenia
Parvovirus B19
Hepatitis + ANA +ve + Anti smooth muscle +ve + raised IgG
Type 1 auto immune hepatitis
Hepatitis + LKM1 + only kids
Type 2 auto immune hepatits
young + episodes of tachycardia + short PR
Lown–Ganong–Levine syndrome
Most common inherited thrombophilia
Factor V Leiden
Tx for anti GBM/Goodpastures
Methylpred Cyclophosphamide Plasma exchange
Amiodarone induced thyrotoxicosis with goitre
ie increased blood flow on thyroid doppler
Type 1
Amiodarone induced thyrotoxicosis without goitre
ie reduced blood flow on thyroid doppler
Type 2
Tx with steroids
Tx for AIT Type 1 (goitre/ increased blood flow on doppler)
carbimazole/potassium perchlorate
Tx for AIT Type 2 (no goitre/ decreased blood flow on doppler)
Steroids
Tx for salmonella gastroenteritis
If immunosuopressed/over >50/ valve disease - cipro
Most common electrolyte abnormality in alcohol withdrawal
Hypophosphataemia
ECG features of HCOM
ST depression Deep T wave inversion LVH
ECG features of LVH
Deep S waves V1, V2 and tall R waves V5, V6
Fitz Hugh Curtis syndrome
PID causing perihepatic adhesions, RUQ pain worse on breathing
Cut off for carotid stenosis
>70%, or 50-69% if symptomatic
Tx for myexedemic coma
Levothyroxine, liothyronine
Tx of sodium valproate overdose
L-cartinine
Bleeding cut off for LP pre thrombolysis
7 days
Bleeding cut off for stroke/head injury pre thrombolysis
3 months
Bleeding cut off for GI bleed pre thrombolysis
3 weeks
NAFLD vs ALFD LFTS
NAFLD ALT > AST
Cirrhosis HCC screening
USS and AFP every 6 months
Hyper IgM syndrome
PCP, hepatitis, diarrhoea
Cancer TTF 1 positive
Lung cancer - NSCLC, adenocarcinomas Thyroid cancer
Lacunar infarct presentation
Unilateral weakness or pure sensory stroke or ataxic hemiparesis
Posterior circulation infarct
cerebellar/brainstem syndrome or LOC or isolated homonymous hemianopia
Tx of NADH methaemoglobinaemia reductase deficiency
Ascorbic acid
Isolation for active millary TB
negative pressure isolation
Anti epileptic causing pancreatitis
Sodium valproate
Tx of ethylene glycol toxicity
Fomepizole Alcohol Sodium bicarb
Histoplasmosis tx
Itraconazole
Tx for Kallmans infertility/ low FSH +LH
Pulsed GNRh
Oculocutaneous albinism Type 1
Light everything
Oculocutaneous albinism Type 3
Reddish hair, blue eyes
Ascites with raised SAAG
related to portal hypertension eg portal vein thrombosis
Cause of hyperglycaemia in malignancy
PTH-RP
HIV med causing fat redistribution/diabetes
Stavudine
Anti malarial worsening psoriasis
Chloroquinine
Vitamin tx in Acute Promyletic Leukaemia DIC
Vitamin A/ ATRA
Coeliac —> weight loss, night sweats, raised viscocity
Enteropathy associated T cell lymphoma
Abx causing obstructive jaundice
Co-amoxiclav
Abx interacting with theophyline
Erythromycin
Features of cyanide poisoning
HTN and bradycardia Then hypotension, coma, SOB, abdo pain
Receptor involved with familial hypercholesterolaemia
LDL receptor
Clicking sound synchronous with heart sounds
Left apical pneumothorax
Organism causing endocarditis in farmers
Coxiella (can be culture negative)
T score for osteoporosis
less than -2.5 at hip or spine or less -1.5 if on steroids
Tick bite in: Massechuteses Long Island Marthas Vineyard Nantucket NY
Babeosis
Diabetes med worsening heart failure
Glitazone
Sepsis with black skin lesions
Echythma gangrenosum from pseudomonas auerginosa infection
Which part of the kidney does gent damage
Proximal tubule
Tx for lewy body dementia
Acetyl cholinesterase inhibitors eg Rivastigamine
Flagellate protazoa in stool
Giardia
Pneumonia w +ve Coombs test
Mycoplasma
Tx for mycoplasma pneumonia
Clarithromycin
Tx for calcium channel blocker overdose
IV Calcium chloride then insulin dex
Tx for low fibrinogen
Cryopreciptate or FFP
STI with multiple painful ulcers and flu like sx
Herpes simplex
Tx for long QT
Beta blocker
Tx for meningococcal mengiitis
IV cef
Tx for Dressler syndrome
Aspirin 650mg QDS
Restrictive lung disease with reduced KCO (transfer factor)
Sarcoidosis
Worms causing GI bleeding
N americanus Ancylostoma duodenale
HIV Itchy rash CD4 <300
Eosinophilic folliculitis
Tx for crytosporidium (ooyst cysts)
Nitazoxinide
Tx for well Mobitz I
Nothing
Tx for Mobitz II
Pacemaker
Vasculitis PR3 +ve
Granulomatosis with polyangitis
Foreign travel reduced ET walking barefoot abdo and chest sx IDA
Hookworm
Hyperviscocity syndrome features
Ax with waldenstroms or multiple myeloma Triad : bleeding gums + visual changes + neurological sx
Type 1 HIIT
48hr-72hr platelets stay >100 no tx needed
Type 2 HIIT
5-10 days platelets drop to <100 Needs tx with danapuroid, lepirudin, argobatran
How does amlodipine OD cause hypotension and tachycardia (mechanism)?
L type calcium channel blockade
Post MI 5-10 days New murmur pansystolic LSE SOB/pulmonary edema/hypotension
VSD
Sx of aspirin OD
tinnitus, vomiting, hyperventilation
Poor school perfomance then seizures and visual deterioration then unresponsiveness/rigidity
Subacute sclerosing panecephalitis (from measles)
Diagnostic test for groin ringworn (tinea cruris)
KOH-treated skin scrapings
Low Hb Low platelets High PPT Low fibrinogen Shistocytes
DIC
ST elevation in I and AVL - MI location
High lateral wall MI
Greyish skin pigmentation
Haemochromatosis
Tx for strongyloides
Ivermectin
Fractures Precocious puberty Cafe au lait
McCune Albright Syndrome
Tx for raised INR warafin if really unwell/risk of major bleed
Prothrombin complex (beriplex)
Deteriorating vision Pins and needles Muscle weakness Hx of autoimmune
hypoparathyroidism (with secondary cataracts)
Legionella rather than mycoplasma
Flu like sx Haemoptysis GI sx Middle aged Office/air con Hyponatraemia
Mycoplasma rather than Legionella
Rash Younger 2w prodrome Can have normal white cells Neuro Haemolytic anaemia
Surveillance for HNPCC
Colonoscopy every 2 years until 40
Primary hyperparathyroidism
High PTH causes high Calcium and low phosphate
Secondary Hyperparathyroidism
Chronic renal failure causes low calcium and high phosphate
Tertiary hyperparathyroidism
Have secondary for ages , so high PTH, high calcium
“wood grain” rash
Erythema gyratum repens EGR paraneoplastic, usually from lung ca SCC Bronchus
Lymphocytic meningitis differentials
TB or crytpococcal
Ix for cryptococcal meningitis
India Ink stain CSF
Tx for latent TB in HIV on HAART
Isoniazid for 6-9 months
Drusens spots in young person
Malattia levantinese Auto dom No tx
Raised congugated billirubin Normal haptoglobins Dark granule hepatocytes
Dubin Johnson sydrome
“Onion skin” periductal fibrosis liver biopsy
PSC
Lung cancer causing hypercalcaemia
SCC
Lutembacher syndrome
mitral stenosis ASD presents as AF and fatigue in 40s
Olaparib MOA
poly ADP ribsome inhibitor PARP
Tx of lithium toxicity
Haemodialysis
HIV LRTI + visual change/GCS change/deranged LFTS
CMV pneumonitis
Haematuria after cyclophosphamide
Bladder ca
Foreign travel + lymphedema + eosinophilia + rash
Lioasis
Mildly elevated urinary cortisol/early morning post low dose dex cortisol
Pseudo cushings
Haemochromatosis + joint pain
Pseudogout/ pyrophosphate arthropathy
Tx for listeria meningitis
Ampicillin and gent
Tx for pen allergic meningitis
Chloramphenicol
Tx for protein C deficiency
Lifelong NOAC
ST depression V1-4 which artery?
Right circumflex
MOA Entacevir
Nucleoside analogue
Tx for bronchopulmonary aspergillosis
Steroids and itraconzole
Abx to avoid to ciclosporin
Erythromycin/ clarithromycin
Monitoring/management for asymptomatic aortic regurgitation
Yearly echo
CD4 cut off for likely PCP
200
Drug causing red man syndrome
Vanc
Tx red man syndrome
Topical steroid
Kallmans MRI findings
absent olfactory bulbs
fever myalgia v unwell new york
West Nile disease
“brown coloured rash on shins” =
pretibial myexedema
Nocardia asteroides
Sulphadiazine
Lofgrens syndrome
Acute sarcoidosis
Lofflers syndrome
Esinophil collection in lungs from parasite
Iron test for haemochromatosis
Transferrin saturation
Tx for hepatorenal syndrome
Terlipressin
Tx for diarrhoea in bile acid malabsorption
Cholestyramine
How does rifaximin reduce hepatic encephalopathy
Decreases ammonia production
Colon IE bugs
strep bovis bacteroides fragiles
Gardners syndrome
Tumours: bone, soft tissue, colon
Focal consolidation in HIV organism
Strep pneumoniae
Diffuse consoldation in HIV organism
PCP
Tx for bleeding/hyperviscocity in Waldenstroms
Plasmapheresis
TRAL antibody mediation
Anti HLA or Anti granulocyte
Mucupurulent cervical discharge
Chlamydia
Cardioversion for AF if young well and no IHD
IV Flecanide
Tx for syphilis in pen allergy
Doxy
Migraine with aura stroke like sx Family hx migraine and early dementia No Vascular risk factors
CADASIL
HLA for chinese patient taking phenytoin
HLA B5102
Bright enlarged liver on USS Raised transaminases No ETOH
NASH
Tx for PCP if pen allergic
Pentamidine nebs Clindamycin + pramaquine + pred
mass in epigastrium + hard palpable liver
gastric carcinoma
What type of renal stones do patients with small bowel syndrome get?
Oxalate
Abdo pain seizures worsening w epileptics neuropathy (mimicking GBS) Low sodium
Acute intermittent porphyria
Tx for acute intermittent porphyria
IV 5% dex saline High carb meal
Polyglandular syndrome Type 1
2 or more of: Hypoparathyroidism Adrenal insufficiency Mucutocutaeous candidia Hypothyroidism Hypogonadism
Polyglandular syndrome Type 2
Type 1 diabetes Hypothyroidism Primary adrenal failure
Tx for adrenal cortical carcinoma
Mitotane
Tx for legionella
Azithromycin
ABx causing blue black pigmentation
Minocycline
Tx for flare of minimal change disease
Steroids
Primary versus secondary pulmonary hypertension
Secondary is due to pulmonary fibrosis
Nuclear pleomorphism and absent mitoses
Bronchial carcinoid
Tx for absence seizures
Sodium valproate
Diabetes with proximal pain and weakness femoral nerve
Diabetic amyotrophy
Tx for TTP
Plasmapharesis
Features of chagas
VTE
Mega esophagus
Conduction defects eg BBB
Mechanism of AIHA with CLL
Autoreactive T cell induction
Mullerans cells
Ovarian ca
Drug for diabetic retinopathy
Ranibizumab
Cause of negative Mantoux in TB
HIV
Causes of torsades
Prolongd QT, AF
Low Mg, Low K, Low Ca2+
Female
Alkalosis
Macrolides, digoxin, sotalol
Tx for VTE in Factor V Leiden
Anticoagulants at least 3 months
Anticoagulation for x2 provoked VTE
6 months
Necrobiosis lipidecta
Tx with topical steroids
?
Retinal vein occlusion
(disc swelling, haemorrhages)
?
Retinal artery occlusion
?
Optic nerve atrophy
Papilloedema
Malignant Hypertension
haemorrhages
cotton wool spoots
optic disc swelling
Diabetic retinopathy
Proliferative retinopathy
AVRNT
Pseudo R waves V1
Chest complication of severe pancreatitis, v unwell
ARDS
When is cardiac resynchronisation therapy indicated?
Max dose of meds including Ivabradine
Ventricular dys-synchrony eg LBBB/broad QRS
Features and management of Bells Palsy
NO FOREHEAD SPARING
Tx - steroids and eye taping
Tx for malignant hypertension/hypertensive encephalopathy
Sodium nitroprusside
Test to differentiate ?pleural plaques vs ?mesothelioma
Pleural biopsy (thorascopy)
Thoracoplasty
rib resection + loss of lung volume
Risk factors for mesothelioma
Abestos
Radiation exposure
(smoking increases risk of abestosis causing mesothelioma but doesn’t cause mesothelioma in itself)
Ventilator settings indicated in ARDS
(PEEP, TV and RR)
High PEEP
Low tidal volume
RR up to 35
Travel to Turkey
Deranged LFTs
Hepatitis A
Hair loss
White patches on mouth and vulva
Lichen planopilaris
Features of WPW (short PR, delta wave)
Surigcal heart repair in childhood
+- collapse
+- palpitations
Ebsteins anomaly
Rash over cheeks, chest, back of hands
SOB, chest crackles
Muscle weakness
Dermatomyositis
(Crackles are ILD)
Abx for CSF leak meningitis (ie Staph aureus meningitis)
IV linezolid
Tx for methotrexate overdose
Calcium folinate
(By passes step folate metabollism step blocked by methotrexate)
Response to desmopression test in cranial DI
urine osmolality should improve to >660
Farmer
Liver cysts/heptomegaly
+- pleural effusion
Deranged LFTs
Eosinophilia
(Dx, Ix, Tx)
Hydatid disease
Dx with ELISA testing for echinococcus
Tx with albendazole +- surgical excision
Management of obstetric cholestasis
Ursodeocyholic acid for sx, rifampicin
If term - deliver baby
Dx and Rx
common in IBD
Pyoderma gangrenosum
1st line - topical steroids
2nd line - topical DMARD eg tacrolimus
3rd line - systemic biological eg Infliximab
Nodular face lesion, sun exposure, most common
BCC
When to stop NAC
INR <1.3
ALT <60/twice upper limit normal
Prognostic markers for myeloma
B2 microglobulin
Albumin
CA FISH
LDH
Diagnosis and management
Severe atopic eczema
1st line - topical steroids
2nd line - topical calcineurin inhibitors eg tacrolimus
Tx for severe psoriasis
Methotrexate
Tx for MODY
Sulphonylureas initially (eg gliclazide)
Probably needs insulin later
CKD or recent contrast scan
Skin tightening
“Woody plaques”
Pulmonary fibrosis/ cardiomyopathy/ pulmonary HTN
Intermittent wheeze, flushing and diarrhoea
Carcinoid syndrome
Ix urinary HIAA
Knuckles, trunk
Diseemenated granuloma annulaire
Lymphoma/HIV
Should resolve over years, otherwise systemic immunosuppression/HAART
Tx for aspirin OD
Activated charcoal
Correction of K+
Urinary alkylisation
Leukaemia
High lymphocytes
abberhent expression of T-cell marker CD5
CLL
Problems releasing grip/ opening closely eyes quickly
Distal weakness
Inherited
Worse in cold weather
Myotonic dystrophy Type 1
Meningitis
Lymphocytic pleocytosis
Ependymal enhacement MRI
CSF: raised protein, low glucose, clear
CMV meningoencephalitis
Bartter Vs Gitelman
Both cause hypokalaemia
Bartters presents profound hypotension childhood,
Gitelman young adults
Gitelman has reduced urinary calcium excretion
Skin abcesses/other infection
Descending paralysis
Bilateral ptsosis
Hypoventilating
Botulism
Indications for specialist liver referral in paracetamol OD
pH <7.3
PT >100
Cr >300
Hepatic encephalopathy III or IV
Sudan black +ve
Myeloperoxidase +ve
Auer rods
Non specific esterase ++
Acute monocytotic leukaemia
Jamaican
Skin nodules
Ulcers
VRDL +ve
Yaws
Chest infection and hepatomegaly from Sri Lanka
(diagnosis and tx)
Amboeiasis - entamoeba histoltyca
Tx with co-amoxiclav, clarithromycin, metronidazole
Vocalisation episodes
Worse at night
Mild post ictal phase
Frontal lobe seizures
Melanosis coli on colonoscopy
Laxative abuse
Senna abuse
Congenital adrenal hyperplasia
enzyme/test
21 hydroxylase deficiency
(also 17 alpha hydroxylase but much less common)
IgA nephropathy (ie mesangioproliferative glomeluronephritis) vs post strep glomeurlonephritis
IgA is within 2-3 days of sore throat
Post strep is weeks after
Goodpastures treatment
High dose pred and cyclophosphamide
Edema
Asthma
Eosinophils
Deteriorating renal function
Esinophilic granulomatosis with polyangitis
pANCA +ve
Tx IV steroids
+- biologics
Best indicator of severity of liver failure in paracetamol OD
PT
Chronic inflammatory condition
+hepatosplenomegaly
+malabsorption
+cardiac disease
+proteinuria
+waxy skin plaques
Amyloidosis
Pink skin papules
+travel Asia
+ abdo pain
+headache
+GI upset
Typhoid
Tx with cef
Breast Ca drug causing heart failure
Trastuzumab
Hypokalaemia
U waves
“Hot and dry skin”
OD
widened QRS
dilated pupils
TCA
Features of amiodaraone toxicity lungs
B/L infiltrates
Pneumonitis
Pleural effusion
Pleuritic chest pain
Cough
Pulmonary fibrosis
Pericardial calcification
eg constrictive pericarditis
“High intensity echo signal around the heart”
on echo
Constrictive pericarditis
Meningitis:
young well person
elevated CSF pressure
high lympocytes
slightly high protein
Viral meningitis
Where is the lesion:
- reduced sensation all 3 branches of trigeminal
- Lateral rectuc is paretic
Left petrous temporal
e.g schwannoma, meningioma, mets, nasophryngeal carcinoma
Anterolateral MI vessel
LAD + circumflex
Diagnostic test for CJD
RT1uIC and 14.3.3 protein analysis in CSF
Drugs worsening psoriasis
Lithium, anti malarials, NSAIDs, beta blockers
Tx for neuroleptic malignant syndrome
Aggressive IV fluids (for rhabdo)
Bromocriptine/dantrolene can be used but not much evidence
renal failure w chest sx
“cresenteric glomerulonephritis with IgG staining on immunofluorescence”
anti GBM
Young person
seizures after waking/myoclonic jerks in the morning
+- generalised seizures
+- absence seizures
Juvenile myoclonic epilepsy
Erectile dysfunction
Tremor
Rigidity
Incomplete voiding
Ataxia
Multi systems atrophy
(if mentions erectile dysfunction, postrual hypotension, urinary frequency or urgency etc - MSA)
Plus parkinsonian symptoms that don’t respond well to tx
LBBB
(M shaped QRS in aVL, notched R lead I, monophasic R wave V6)
Tx for Lambert Eaton Syndrome
3, 4-diaminopyridine
How to diagnosis for IgA nephropathy
Renal biopsy
(blood levels IgA will be raised but are non specific)
What type of creature spread Dengue?
Aedes mosquito
Fever
Macular rash
“bone breaking” muscle and joint pain
Worst headache ever
Vomiting
Travel
Dengue
Post pancreatitis:
Abdo pain
Mass
Fever
Persistently raised amylase
Pancreatitic pseudocyst
How do you diagnosis Whipples disease?
Jejunal biopsy
shows macrophages +ve PAS (periodic acid schiff staining)
Pale conjunctivae
Blue lines on gums
(Dx and Tx)
Lead poisoning
Dimercaptosuccinic acid
Erythema nodosum
Painful, red tender nodules
Ax with throat infections, sarcoid, IBD TB, leprosy
Tx for bifasicular block with pauses
PPM
STI with rash on soles of feet
Keratoderma Blennorrhagcia
Ax with chlamydia
(often ax with reiters syndrome)
Increase in total T3/ T4
Normal free hormones
Pregnancy
Gastric ulcer
Tx for carbon monixde poisoning
100% O2
can consider hyperbaric O2
ventilation only if comatose
Ataxia
Deafness
Epilepsy
DM
Eye movement problems
Maternal inheritance
Mitochondrial disorder
Live vaccines
Mumps/MMR
BCG
Typhoid
Yellow Fever
Chicken pox
Recommended vaccines for HIV
Pneumococcal
Flu
Hep A, Hep B
Management of Barrets
Low grade dysplasia - repeat OGD 6 months
High grade dysplasia - consider endoscopic ablation therapy
Management of Melanoma
Exicison with at least 1cm margin
Abdo pain
Ascites
Hepatomegaly
Prolonged PTT
Budd Chiari
(from clot from lupus)
Veil sign
Loss of left heart border
Left sign white than right
Shows LUL collapse
Tx and prophylaxis of cluster headaches
Tx - high flow O2 and triptans
Prophylaxis - verapamil
Drug tx for prolactinoma
Bromocriptine
(can also use ropinerole)
Tx for depression with psychotic features in PD
Clozapine
Treatment for premature ventricular ectopics
Beta blockers
Precordial heave
Wide split second heart sound
Pulmonary flow murmur
RBBB
Prominent pulmonary arteries
ASD
Needs echo and right heart catherisation ?suitable for closure
MEN I
3 P’s
Parathyroid
Pituitary
Pancreatic
MEN IIA
2 P’s, 1 M
Phaechromocytoma
Parathyroid
Medullary thyroid cancer
MEN IIB
Medullary Thyroid Cancer
Phaeochromocytoma
Marfans/neuromas
Management when unable to wean steroids after 12 months PMR
Add tocluzimab
Cancers ax dermatomyositis
Bronchial carcinoma
Esophageal carcinoma
Tx for Crohns flare in pregnancy
Steroids
How to differentiate between Progressive multi focal leukoencephalopathy and HIV encephalopathy
PML will be JC virus +ve
How do you differentiate between cervical myelopathy and MND
Cervical will have primarily sensory sx, MND sensation is intact
Buccal pigmentation - suggests adrenal insufficiency/Addisons
“absent erythropoesis” on bone marrow
Pure red call aplasia
Intrahepatic cholestasis of pregnancy Vs Acute fatty liver of pregnancy
Cholestasis: v high ALP (obstructive LFTS), prolonged PT, malaise, pruritis
AFLP: all transaminases raised, more unwell - abdo pain, encephalopathy, DIC, raised WCC
What counts as a positive Schirmers test?
<5mm wetting per 5 mins
Diabetic
Worsening glycaemic control
weight loss
Loose stools
Pruritis skin rash
Glucagonoma syndrome
Features of glucagonoma syndrome
(4 Ds)
Dermatitis (necrolytic migratory erythema)
Depression
DVT
Diabetes
Which is Epley and Dix Hallpike
Dix Hallpike - diagnostic
Epley - manouevre
Young person (usually woman)
Flash pulmonary edema
HTN
Fibromuscular dysplasia
Immunoglobulin raised in ABPA
IgE
What is fenofibrate for?
Hypertriglyceridaemia
NOT HIGH CHOLESTEROL
Name and ax condition
Granuloma annulare
Diabetes
Dermatomyositis
Gottrons papules
Bug indentified at revision of prosthetic joint but not causing any issues or symptoms
Propionibacterium acnes
Initial LOC then recovers, then drops GCS again
Head injury
Extradural haematoma
Ventilation settings for COPD
PEEP no more than 12
Causes of lymphocytosis meningitis
EBV
TB
Weight loss
Night sweats
Haematuria
Variocele
Renal cell carcinoma
Features of androgen insensitivity syndrome
Normal external genitalia
No internal female organs
B/L undescended testes which present as BL inguinal hernias few weeks after birth
Absent or reduced pubic hair
XY karyotype
RTA 1 features
(all are hyperchloraemic metabollic acidosis)
Hypokalaemia
Nephrocalcinosis
Hypercalciuria, ax with auto immune
unable to generate acid in distal tubule
RTA 2 Features
Ax with Fanconi syndrome, myeloma or acetozolamide/sulfonamides, Wilsons
Increased urinary excretion of: glucose, uric acid, phosphate, amino acids, citrate, calcium, K+, protein
can’t reabsorb bicarb
causes osteomalacia
Tx with citrate and K+ supplementation
RTA 4 features
Deficienct aldosterone action on distal tubule
caused by diabetic nephropathy or chronic interstitial nephritis
Hyperkalaemia
Can be precipitated by ACEi or mineralocorticoid receptor antagonists
Failure of ventricular capture
Most likely organism for endocarditis in native valve and dental procedure
Strep viridans
Deranged LFTs with no/only slight raise in ALP
AMA +ve
(Dx and Tx)
Auto immune hepatitis
Prednisolone
Tx for familial transthyretin amyloidosis
Tafamidis
Mechanism of promthrombotic state in nephrotic syndrome
Decreased anti thrombin III
(is lost in urine with the albumin)
Left sided abdo pain
bloody diarrhoea
Travel/day care/hostel
(Dx and Tx)
Shigella
Tx with azithro
Normal pressure hydrocephalus
Failed ventricular capture
(ie pacing spike doesn’t transmit to ventricles, pacing spikes without QRS or then with weird broad QRS)
“Owl eye” on MRI spine
Spinal infarct
Antibody for systemic sclerosis
Anti-scl70
Hypoxia + pulmonary edema + pulmonary haemorrhage
Recently ventilated and extubated
Obese/airway obstruction
Blood stained fluid from chest suction
Haemorrhage pulmonary edema
Cameroon
Drancunculus (guinea worm)
from unfiltered water
blister with worm track under the skin
Esophaegeal malignancy
Similar to achalasia but achalasia would be smooth below narrowing (plus not have red flag sx)
Biltaeral hydronephrosis - ureteral dilatation
Whats the mechanism of VT in:
a) pacemaker
b) temporary pacing wire
pacemaker - undersensing of atrail and ventricular signals
pacing wire - lead displacement
Cirrhosis
Tx for Pelvic Inflammatory Disease with chlamydia
IM cef
+
14 days doxy BD
+
14 days metronidazole BD
Impaired fasting glucose tolerance definition
6.1-6.9
Fasting glucose level diagnostic of diabetes
>7
Impaired glucose tolerance definition
7.8-11.1 after food or 2 hour OGTT
Vesitubular schwannoma
Tx for diabetic retinopathy
Ranibizumab (anti VEGF)
Focal photocoagulation
KUB malignancy causing polymyalgia type syndrome
Renal adenocarcinoma
mechanism of ACEi induced angio edema
Increased bradykinin
Management for adrenal insufficiency in labour
100mg IV hydrocortisone evey 6 hours
Tx for methanol/ethylene glycolFome overdose
Fomepizole
Tx for hydatid disease
Albendazole
Tx for sx of PBC/hyperbillirubinaemia
1) Ursodeoxycholic acid
2) if end stage disease of pregnant - colestryamine
Bullous pemphigoid biopsy findings
Linear IgG deposits at dermal-epidermal junction
Pemphigus vulgaris biopIgGsy findings
IgG deposition throughout dermis
Hilar mass causing Cushings syndrome
Small cell carcinoma of bronchus
Obese
Pitting edema to knee
Erythema
Eczema
Hyperpigmentation medial ankles
Normal pulses
(Dx and Tx)
Stasis dermatitis
Tx with compression bandaging
Felty syndrome triad
RA +Splenomegaly +neutropaenia
+anaemia
skin ulcers
leg pigmentation
Globally increased uptake, likely Graves
Palpitations and preisyncope in myotonic dystrophy
Atrial tachycardia - like pAF
Branch retinal vein occlusion - flames are only over one half
Bug causing painful cervical lymphadenopathy in HIV
Mycobacterium avium
Compression bandaging ABPI cut off
>0.8 triple layer bandaging
0.5-0.8 lesser bandaging
<0.5 not suitable
HCOM
Auer rods
AML
Insulinoma
Direct antiglobulin test in AIHA
+VE
Direct antiglobulin test in G6PD
-ve
Left atrail myxoma
Travel (Colombia)
Began as erythematous plaque
Developed into painless ulcer
Cuteanous leishmaniasis
Flu like symptoms
Painful thyroid
Hyperthyroidism
Subacute thyroiditis
Don’t treat
Neuropathic ulcer
Callus edge
Clean base
Indications for DigiFab
Haemodynamic instablity
Life threatening arrythmia
K+ >5
plasma digon >13
ingestion >10mg adults or >4mg kids
recurrent bradycardia
Tx for dermatitis herpetiformis
Gluten free diet
Dapsone
Sulfapyridine PO - risks of agranulocytosis
Neurofibromatomas features
Cafe au lait spots
axially or inguinal freckles
Neurofibroma
Optic nerve glioma
(2 or more) Iris haemartomas
Sphenoid dysplasia or long bone abnormalities
Electrolyte disturbance with cisplatin
Hypomagnesaemia
Tx for thyrotoxicosis in pregnancy
Propylthioraci 1st 3 months
Carbimazole after that
TB med causing:
confusion
seborrheic dermatitis
stomatisis
peripheral neuropathy
Pyridoxine deficiency from Isoniazid
(replacement worsens PD symptoms)
Cicatrical alopecia
Telogen effluvium
Non scarring hair loss due to stress
Alopecia areata
Non scarring
pruritis or burning sensation
Broken hairs - exclamation points
E HISTOLYTICA TREATMENT
METRONIDAZOLE
Delta sign
Saggital sinus thrombosis
Multi ring enhancing lesions
Toxoplasmosis
Parkinsonism
Postural hypotension
Hallucinations
Low Mood
Lewy Body Dementia
Meds then —>
worsening renal function
white cells, protein and blood on urine dip
K+ high
eosinophilia
rash
Acute interstitial nephritis
Causes of acute interstitial nephritis
Mycoplasma
NSAIDS
Penicillin
Diuretics
Cephalosporins
K+ >5.5 pre renal transplant surgery
Do extra dialsysis
Stanford A aortic dissection
Ascending aorta
Stanford B aortic dissection
Descending aorta
What ODs can you use activated charcoal in?
Carbemazipine
Dapsone
Phenobarbital
Digoxin
Theophylline
Quinine
Biologics for psoriasis
Etanercept
Infliximab
Adalimumab
Ustekinumab
Tumour with:
- raised HCG
- normal AFP
- normal CEA
Testicular choriocarcinoma
Painful eye with perilimbal injection
photophobia
pain on eye movement
blurred vision
Anterior uveitis
ax with sarcoid
Painful eye with gritty feeling
Episcleritis
Painful eye with
severe eye pain which deteriorates with movement, possibly affecting vision
Scleritis
Features of theophyline toxicity
Tachycardia
Vomiting
Hypokalaemia
Hyperglycaemia
Mild acidosis
Type of hepatitis transferred with unscreened blood transfusions eg Haemophiliiacs from other countries
Hep C
Treatment for Lewy Body Dementia
Rivastigmine
Bandage for pressure sores
Calcium alginate
Then hydrocolloid
Silicosis
CKD + pericardial rub
Uraemic pericarditis
Risk of cardiac tamponade
Needs urgent dialysis
Mechanism of steroids causing osteoporosis
Alteration of parathyroid hormone
Tx of multi focal atrial tachycardia in COPD
Verapamil
Is MND upper or lower motor neuron?
Both
Muscle weakness - quadriceps and finger flexors
Mild CK rise
Inclusion body myositis
Causes of absent ankle reflexes and upgoing plantars
Syringomylia
Fredreichs Ataxia
Conus medullaris
MND
Subacute combined degeneration of the cord
Taboparesis (teriary neurosyphilis)
What is sick euthyroid syndrome?
Due to illness
Low T3, T4
Normal TSH
Don’t treat will self resolve
Subclinical hypo/hyperthyroidism
TSH is off but T4/T3 fine
Cat scratch disease
Bartonella
Self resolves or azithro for severe lymphadenopathy
Tx for gonorrhea
IM cef
Or Azithro if pen allergic
Anti psychotics causing weight gain/T2DM
Olanzapine
Clozapine
VIPoma
vasoactive peptide secreting tumour of pancreas
flushing, diarrhoea, hypokalaemia, acidosis
half are malignant
Tx for typhoid
Ceftriaxone
Rash worse on hands and nipples
Scabies
Pearly nodule with overlying telangectasia
BBC
Pulsatile tinnitus
X, XI, XII
+- flushing, sweating, headache
paraganglionoma
dysphagia woserning as you eat,
improves after regurgitation
pharyngeal pouch
Hunter criteria serotonin syndrome
Spontaenous clonus
Inducible clonus with tremor/sweating
Ocular clonus plus agitation or sweating
tremor with hyperreflexia
hypertonia and temp >38
Rash after cipro and sun exposure
Phototoxic reaction
Campylobacter
Sx of vertebral artery dissection
Dizziness, vertigo, nausea
(can be ax with infarct of posterior inferior cerebellar artery)
Basilart artery stroke
Locked in syndrome
Reticular rash
Gangrene/ulcers/necrosis
VTE
ax w SLE/ Hep C/RA/ Sjorgens
Cryoglobulinaemia
Polyarteritis Nodosa
Hep B
Mononeuritis
Weight loss
Livedo reticularis
Renal impairment
Giant a waves
Pulmonary/tricupsid stenosis
Smudge/smear cells
CLL
Blast cells
ALL
Most common renal disease in adults
Focal segmental glomerulonephritis
Overweight
Raised AST, ALT
Normal ALP
Steato hepatitis - NASH or alcoholic
Grey/white membranes on tonsils
Diptheria
1st tes is PCR for dipetheria toxin
Then culture and Elek testing
Freidrichs ataxia
Progressive ataxia
cerebellar ataxia
progressive LL weakness
can have pes cavus/scolisos
eye/hearing problems
Tx for RA in pregnancy
Sulphasalazine
2nd line azothioprine
Can give TNF alpha in early pregnancy but not ideal
Main ABx to avoid in myasthenia
Gent, clarithromycin. erythromycin
Effect of diabetes on cholesterol
Low HDL
High tryglycerides
Mediterrean or African
Recent meds (Abx)/food —>
Jaundice, abdo pain
Low Hb
High LDH
Urobilligen +
Heinz bodies, Bite cells
G6PD Deficiency
Oculogyric crisis
Dopamine blockade at basal ganglia from eg Metoclopermide
Tx with procyclidine or trihyxphenidyl (benzhexol)
Signification of calcified diaphragm
Abestosis
Questionnaire for social anxiety
Mini Spin
GAD
Tx for restless legs
Pramiprexole
Tx for Shigella
Azithro
First cardiac marker to be elevated
Myoglobin
Rx of keloid scars
1st line - intralesion triamcinolone
2nd line - intra lesional 5 fluorouracil
3rd - radiotherapy and surgery
brain met
Liddles syndrome
Hypokalaemia metabollic alkalosis
Hypertension in adolesence
Mononeuritis
Vasuculitis
SOB
Esinophilia
pANCA +ve
Esinophilic granulomatosis with polyangitis
Inclusion bodies on colon biopsy
CMV infection
tx with ganciclovir
Trifsacicular block
Needs PPM
Meningitis with SIADH
B/L VI nerve palsies
TB
INR 5-8 no bleeding
stop warfarin
INR >5 with minor bleeding
IV Vit K
INR > 8 no bleeding
IV vit K PO (IV prep PO)
Diarrhoea
immunocomprised
cysts
Acid fast +ve
Cryptosporidium
Deranged LFTs after high risk sex
Hep B
Hormone secreted by MEN parathyroid cancer
Calcitonin
Thickened gallbladder and pericholecystic fluid
No gallstones
ITU/burns
Acalculous cholecystitis
How to differentiate between hyperaldosteronism due to Conns vs due to fibromusclar dysplasia
Conns has supressed plasma renin
fibromusclar dysplasia has elevated plasma renin
Anti MPO +ve
microscopic polyangitis
(or other small vessel vasculitis eg rheuamtoid vasculitis)
Lichen planus
LIF pain and temp
Diverticulitis
Vasculitis with nasal sx
Granulomatosis with polyangitis
Succession splash
Gastroparesis
Nephropathy improving quickly with steroids
Minimal change
Rapidly growing keratotic lesion
Immunosuppressed
Sun exposed area
SCC
Needs excision
Pityriasis versicolour
Management of CLL
Usually nothing
if; fever, weight loss, night sweat, bone marrow suppresion - can give biologics
Bug if meningitis from ear infection
Strep pneumoniae
Subarachnoid haemorrhage
Extra dural haemorrhage
Subdural haemorrhage
Meningoma
Glioblastoma
HSV Encephalitis
What does bicalutamide do?
Reduces tumour flare w goserelin
How to diagnose sarcoid with BHL
Transbronchial needle aspiration
Test for post strep glomerulonephritis
Anti streptolysin O titre
Spike and dome renal biopsy
Membranous glomerulonephritis
Alternative to eGFR if you’re dead muscley
C Cystatin
Haematuria in sickle cell
Papillary necrosis
Meningitis bacteria if neurosurgery
Staph epidermis
Tx for nacrolepsy
Modafinil
Tx for nacrolepsy/cataplexy
Oxybate
Tx of aortic root dilatation in Marfans
Bets blockers
Toxoplasmosis Retinits
Retinal detachment
AKI + eosinophilia
Acute interstitial nephritis
HPOA
NSCLC
Periosteitis
Tx for cyanide poissning (polyuerthane)
Dicobalt edetate
PR3 +ve
Granulomatosis with polyangitis
Erythema multiforme
Drusen spots
Tx for Wilsons
Trietine
Antibody for auto immune hepatitis
Anti smooth muscle
Anti nuclear antibody
Tx of hyperparathyroidism in renal disease
Alfacalcidol
Cinacalcet if on dialysis and not fit for surgery
Aortic dissection management
Type A (involving ascending aorta) - surgery
Type B - IV labetolol
Medicines worsening.causing gallstones
Fenofibrate
Tx for organophosphate poisoning
Atropine
Pralidoxime
Tx for myasthenia if sx not resolving with pyridostigmine
IV immunoglobulin
Treatement threshold of kappa IgG paraprotein in myasthenia
>30
Pressure sore dressing (exudate vs no exudate)
No exduate - hydrocolloid
Exduate - alignate
