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SH
Dr. SINBOONA
ARARSA (MD)
2021 G.C
OROMIA,ETHIOPIA
0 | P a g e
SHORT MEDICAL PEARLS
DR.SINBOONA ARARSA (MD )
ADMIN
JIMMA UNIVERSITY MEDICAL CENTER | OROMIA,ETHIOPIA
Dr. SINBOONA ARARSA KENENI
(MD) ,GENERAL PRACTITIONER
AND LECTURER AT JIMMA
UNIVERSITY MEDICAL
CENTER,OROMIA, ETHIOPIA 2021
SHORT MEDICAL PEARLS
o CCONO
CONTENTS
1.NEUROLOGY…………………
2.PULMONARY ……………………
3.GIT+HEPATOLOGY……………...
4.CARDIOLOGY ………………….....
5.NEPHROLOGY ……………………………......
6.HAEMATOLOGY ………………
7.ENDOCRINOLOGY……………
8.RHEUMATOLOGY………………
9.INFECTIOUS DISEASE …………….
10.DERMATOLOGY…………………
11.PHARMACOLOGY
&TOXICOLOGY………………………..
12.PSYCHITARY ………………………
13.ONCOLOGY…………………………
14.OPTHALMOLOGY…………………
15.CLINICAL
SCIENCE…………………………………
16.REVIEWS………………………………
Neurology
Pearls
1.Best parameter to monitor in GBS is
=Forced vital capacity
2. Young patient +Cerebellar
hemgioblastomas+polychethemia+kidney
cyst + renal cell carcinoma is =von hippel
landau syndrome
3. Middle aged lady+ personality changes +
sexual habits + inappropriate in social
situations + repeatedly asking same
questions+=picks disease
4. 1st line treatment to prevent vision loss in
idiopathic intracranial hypertension is=urgent
LP shunt
5. Sensor neural deafness + absent
corneal reflex absent + facial nerve palsy
=Acoustic neurom
6.Young patient + ipsilateral headache +
ipsilateral Horner syndrome +
contralateral hemiparesis +neck pain
=Carotid artery dissection
7. 1st line drug in status
epileptics is
=Benzodiazepines IV
Lorazapam
8. Patient on neuroleptic treatment
+visual hallucinations +features of
Parkinson +dementia less than 1 year is =
lewy body dementia
9. History of migraine with Aura +stroke
+positive family history of migraine and early
dementia is=CADASIL (cerebral autosomal
dominant arteriopathy with subcortical infract
and encephalopathy)
10. Visual hallucinations in clear conscious +
visual field defect + MME score for dementia is
normal + history of glaucoma or cataract is
=Charles Bonnet syndrome
11. Deafness + pulsatile tinnitus + cranial
nerve IX,X1+ pulsatile reddish blue mass in
tympanic membrane =Glomus jugulare
tumour.
12. 1st line drug treatment in neuroleptic
malignant syndrome is = Bromocriptine
13. Young patient +pain after excessive
exercise +Dark urine /tea coloured urine is =
McArdle disease Do muscle biopsy
14.Young patient +lancinating pain
in extremities after vigorous
exercise +stroke + angiokartomas
periumblicaly is = Fabry's disease
15. Young patient + opthalmoplegia+
ptosis +Retinitis pigmentosa (RP)
+cerebral syndrome +cardiac
conduction defect + hearing loss
is=Kearns Sayre syndrome
16. Iv drug use + descending progressive
weakness +Cranial nerve involvement
affecting ocular movement
o swallowing facial musculature
+autonomic features +loss of
reflexes is= Botulism
17. Optic neuritis + myelitis + vomiting +
Aquaporin 4 antibody+ MRI spinal cord
lesson extend over 3 vertebral segment =
Neuromyelitis optical/ Devic's disease
18. . 30 to 50 years + chorea(piano
playing)+ personality changes + unsteady
gait + dementia + saccadic eye movement
+ lack of coordination + caudate nucleus
atrophy putamen atrophy =Huntington
disease
Rx ,,,,treatment with tetrabenazine
19. History of viral infection + recurrent
vertigo + nausea , vomiting + horizontal
nystagmus + no hearing or tinnitus
is.......Vestibular
neuronitis
20. Investigation of choice to diagnose Carotid
dissection is ......Ct Carotid angiogram
21. Distal weakness + common peroneal
palsy +ulnar nerve palsy + pescavus +
clawed toes+ areflexia+ kyphosis is.........
Charcot Marie tooth disease
22. Yoga exercise +neck pain + occipital
headache + numbness of face + loss of pain and
temperature ipsilateral + nausea ,vomiting
vertigo +nystagmus is =Vertebral artery
dissection
diagnostic test is =MRA brain
23. Peripheral neuropathy + sensorneural
deafness +anosmia +cerebral ataxia + pes
cavus+ night blindness+ cardiomyopathy +
retinitis pigmentosa + short 4th and 5th toe
+high phytic acid is = Refsum's disease
24. Multiple nerves involvement + conduction
blocks + fasciculation + sensory exam normal +
reflexes normal +anti GM1 antibodies high
=Multifocal motor neuropathy treat with
immunoglobulin's
25. Headache ,vomiting +local infection
sinusitis + perioribital oedema +
opthalmoplegia 6th CN+ 3rd and 4th nerve +
5 CN hyperaesthesia if upper face and eye
pain is=Cavernous sinus thrombosis
26. Lower limb is more involve than
upper limb contralateral hemiparesis
=Anterior cerebral stroke
27. Upper limb \face more involve than lower
limbs contralateral hemiparesis =middle
cerebral artery stroke
28.Agitation+hallucinations+delusion+seizur
es+dyskinesia +ovarian tumours + MRI
normal or showing deep subcortical limbic
structures =Ct scan of abdomen pelvis
confirms ovarian carcinoma + antiNMDA
antibodies is=Anti NMDA rec encephalitis
give iv steroids and immunosuppression
29. After Ct scan confirm nontruamatic SAH next
step is to confirm It by Urgent angiography thru
Ct scan or MRI before endovascular clipping or
coiling
30. Seizures + behaviour changes like patient
accuses her wife of having affair with pm +
headache + oral facial dyskinesia + insomnia is=
Autoimmune limbic encephalitis
31. Cancer patient /chronic immunodefient state/
immunosuppressive drugs +personality changes
+intellectual impairment + focal neurological signs +
cortical blindness + seizures + coma + csf normal +
MRI non enhancing white matter lesions + jc virus
is=Progressive multi focal leucoencephlopathy
32 . Most accurate test for myasthenia gravis
is=Single fibre electromyography
33. Moderate sized haematoma in basal ganglia with
minimal mass effects next step is=Admission to stroke
unit or observation
34. L4 =i) anteromedial part of shine ii) knee reflex hip
adduction ,knee extension, ankle dorsiflexion and foot
inversion
L5=hip extension, knee flexion, ankle dorsiflexion, big toe
extension
S1=sole of foot, ankle reflex ,hip extension, ankle
plantar flexion and foot eversion
35. Radiotherapy more than chemotherapy in
neurooncology
36. Smacking his lips and spontaneous recover
+remain unaware of episode +as child had history of
febrile convulsion ,is=complex partial seizure
37. déjà vu + epigastric sensation fallowed by loss of
consciousness + lip smacking + history of febrile convulsion
is =temporal lobe epilepsy do
MRI
38. Short stereotyped events + abrupt onset
termination + bizarre voculations + nocturnal nature
of events is = Frontal lobe seizures
39. Opthalmoplegia +disturbance of consciousness +
ataxia + hyperreflexia + antiGqIb + history upper tract
infection is=Bicker's staff brain stem encephalitis
40. Young women + dilated pupil one is larger than
other + absent ankle/knee reflex + mostly
unilateral + slow reactive to near accommodation
reflex is =Holmes Adie pupil
41. Dix Hall pike manoeuvre help in diagnose of benign
positional vertigo ,Epley manoeuvre treat benign
positional vertigo.
42. Sudden loss of vision + optic nerve swollen +
retinal haemorrhages in all quadrants + affarent
pupillary defect is=CRVO treat with steroids or
antiplatelet
43. Investigation of choice for CRVO is =Fluorescein
angiography
44. HIV patient + neck stiffness + photophobia + mild
raise csf protein ,decreased csf glucose ,lymphocytic
pleocytosis+MRI ventricular enlargement with
ependymal enhancement +gradual memory loss is= Cmv
meningoencephalitis
45. Chinese /Japanese + stenous exercise + meal rich in
carbohydrates + heaviness in limbs + palpitations +
tendon reflexes hypoactive, plantar mute =thyrotoxicosis
hypokalemic periodic paralysis
46. Patient already on antiepileptic sodium valproate then
continue at low dose and give folic acid and do scan at 12 week
47. Loss of fingers touch, vibration,proproception on
ipsilateral side + hyperreflexia, extensor plantar on
ipsilateral side + segmental anaesthesia at level of lesson
loss of pain and temperature on contralateral side is
=Brown sequard syndrome
48. Alien limb i.e. limb arm moves on it's own +
sensory loss + supranuclear gaze palsy + non fluent
aphasia + adult onset Parkinson disease is=
corticobasal degeneration
49. Investigation for CADSIL is =Notch 3 genetic testing
50.Nystagmus+ophthalmoplegia+ataxi
a+alchlocs+ confusion + peripheral
sensory neuropathy decrease red cell
transketolase is = Wernicke's
encephalopathy
Treatment = give thiamine
Unilateral complete Ptosis + Normal/
Mydriasis ---
3rd nerve Palsy
Unilateral partial Ptosis + MIOSIS---
Horner
Ptosis + NO Opthalmoplegia---
Myotonic dystrophy
Bilateral
Bilateral Ptosis + Opthalmoplegia---
Myasthenia Gravis
52.vesticular schwanoma has
unilateral symptoms unlike Minners
disease which is bilateral
53.Buttock and thigh claudication + normal
straight leg raise + pain relieved by rest is =
lumbar Spinal stenosis
Investigations are : MRI shows loss of
epidural fat on T1 weighted images loss
if csf signal around Dural sac and
degerntivr disc disease
Treatment : DE compressive lumbar
laminectomy first line surgical
intervention.
54.Normal straight leg raise in spinal
stenosis differentiate it from other
causes of lower limb nerve pain.
55.In prolapsed lumbar disc there is pain
on straight leg raise
56.HTN + localized cerebellar signs =
Cerebellar haemorrhages
57.In MS if significant residual volume = self
Catherization
. If no significant residual volume then
= {anticholinergic oxybutynin,
imipramine
58.Botox in urge incontinence
Pelvic floor exercise for stress incontinence.
59. L2 = hip flexion
L3=knee extension
L4=ankle dorsi flexion
L5=great toe extension
S1=ankle plantar flexion
S2=knee flexion
60.Lesion in ventral pons leads to locked in
syndrome include tetra paresis with loss of
lower cranial nerve resulting in bilateral
facial nerve palsy and dysphagia.
• RESPIRATORY
PEARLS
1.Gold standard diagnostic test for
Obstructive sleep apnoea = Polysomnography
2 .Yellow discoloration of nails + lymphedema
+pleural effusion + bronchiectasis is = yellow nail
syndrome
3.Obese man + tired all time day time
somnolence + apnoea at night reduced REM
sleep + snoring + Hypertension + retained C02
is=obstructive sleep apnoea syndrome (sleep
apnoea/hypopnoea
4. HRCT is investigation of choice in idiopathic
pulmonary
fibrosis showing honey combing
5. Pulmonary function in obesity
Restrictive
No effect on KCO
6. Findings of obstructive pattern:
FEV1 significantly reduced less 70%FVC reduced or normal
FEV1/FVC =reduced less than 80% or 0.7Raised total lung
capacity Raised residual Volume
7. Findings of restrictive pattern:FEV1 reduced less than
80%FVC =significantly reduced FEV1/FVC =normal or increased
more
than 80%Lung compliance , TLC RV are decreased
8. Causes of obstructive pattern :
COPD
Asthma
Bronchiectasis
Bronchiolitis oblitera
9.Causes of restrictive pattern
Idiopathic pulmonary fibrosis
Pulmonary haemorrhages
Asbestosis
Sarcodosis
ARDS
Extrinsic allergic alevolitis
Histocytosis Coal worker's pneumococcal
Polio
Myasthenia Obesity
Scoliosis
10. Causes of increased TLCO :
Most obstructive has low TLCO except Asthma
Pulmonary haemorrhages ( Wagner's, good pasture) Left to
right shunt Polchythemia Exercise
Male Hyperkinetic state
11. Causes of Low TLCO:
All restrictive gives low TLCO except pulmonary haemorrhages)
Pulmonary fibrosis Pulmonary emboli
Emphysema Pulmonary oedema
Anaemia Low CO
Pneumonia
Sarcodosis
12. Pulmonary function in obesity
Restrictive
No effect on KCO
13.Causes of high KCO with normal or low TLCO
Lobectomy / pneumoectomy
Neuromuscular weakness Scoliosis/kyphosis
Ankylosing spondylitis
14. KCO reduced in
interstitial lung disease
Restrictive disease
Pulmonary embolism
Vasculitis
15,KCO increased in:
Haemorrhage Polchythemia
16. Young patient with DM + recurrent chest infections +
Diarrhoea + abnormal LFTs + gallstones + steatorrhoea +
constipation is = Cystic fibrosis
17. Features of cystic fibrosis
Delayed puberty Short stature
Pancreatic polyps
Diabetes Miletus
Rectal prolapse
Male infertility (due to Mal development of vas deferens
Female subinferlity
Meconium ileus
18.Oragnisms in Cystic fibrosis patients Infants and
young children = Staphylococcus aureus, Haemophilu
Teenagers = Pseudomonas aeruginosa treated by
inhaled tobramycin Aspergilus Burkholderia cepacia
‣ Mycobacterium tuberculosis
19.Teenger with Cystic fibrosis presents with chest infection
treated with ceftazidime + tobramycin
20.Rapidly progressive fever + high volume of
purulent sputum uncontrolled bronchopneumonia
weight
loss septicaemia by Burkholderia cepacia
treated by Ceftazidime+aminoglycosides
21.Lab of cystic fibrosis :
Sweat test :sweat chloride more than 60mmol/L
Decreased chloride secretion
increased sodium absorption
CFTR gene Genetic test is confirmatory
F508(DF508)mutation on chromosome 7
22.Treatment of cystic fibrosis :
Chest physiotherapy postural drainage
High calorie + high fat Vitamin D
Pancreatic enzymes
Supplement N- Acetylcystein
Heart lung transplant
Gene therapy Human Recombinant DNASE
23.CT scan of Chest is diagnostic for
pancoast tumour.
24.Diagnostic investigation of choice for sarcodosis
is = Trans bronchial lung biopsy
25.Mangement of obstructive sleep apnoea is :
Weight loss
CPAP is first line for moderate and severe OSA
Intraoral devices ( Mandibular advancement )
If CPAP is not tolerated Uvulopalatophrngraphy
Tracheostomy is last resort.
26.Epworth sleepiness in obstructive sleep apnoea is:
Mild = 4-14
Moderate=15-30
Severe = more than 30
Mild is treated by weight loss
Moderate and severe is treated by = CPAP
27.Survival benefits in stable COPD patients are :
Smoking cessation
LTOT
Lung volume reduction surgery
Steriods reduced exacerbation frequency but not the mortality
28.peripheral edema + raised JVP +SYSTOLIC Parasternal heave
+ loud p2 + COPD is =. Cor pulmonale
Treatment is = loop diuretics for oedema
LTOT
ACEI ,CCBs ,Alpha blockers are not recommended.
29. Indications of LTOT are :
pO2 of < 7.3 kPa (55 mmhg) or to those with a pO2 of
7.3 - 8 kPa( 60mmhg ) and oneof the following:
secondary polycythaemia nocturnal hypoxemia
peripher
al
oedema
(cor
pulmona
le )
pulmona
ry
hyperte
nsion
At least 15 hours a day.
30. Patients who are critically ill (anaphylaxis is ,shock)
oxygen should be at 15 /min.
31.carbon monoxide transfer factor shows prognosis in
= idiopathic pulmonary fibrosis .
32. 50-70 years + exceptional dyspnoea + bilateral
fine basal crackles + clubbing + dry cough + restrictive
spirometry is = Idiopathic pulmonary fibrosis .
33.indications of lung volume reduction surgery :
1. CO2 retention 7.3 cut of
2.severe limitation of exercise
3. upper lobe emphysema
34. Treatment of idiopathic pulmonary fibrosis :
Prednisolone 0.5 mg
LTOT
Lung transplantation .
Pulmonary rehabilitation
Pirfenidone ( antifibrotic agent )
Interforne gamma 1 beta and bosentan
Nintendanb.
35. if PH is less than 7.25 = give invasive
ventilation.
36. NIV complication = pneumothorax
37.Treatment of exacerbation of COPD
:
Increase frequency of bronchodilator
give via nebulizer
Prednisolone 30mg for 7-14 days.
38.History of tuberculosis / cystic fibrosis
+ haemoptysis + cough + chest round
opacity surrounded by rim of air + serum
increase titre Aspergilus precipitants ( IgG
antibodies ) is = Aspergiloma .
39. Treatment of Aspergiloma .
Surgical resection
Long term itraconazole if not fit for
surgery.
Life threatening
emoptysis=after transfusion and
resuscitation angiography and arterial
embolization after that lobar
resection as intervention of last resort
• 39
40.Asbestosis occur in Plumber , boiler , shipyard , pipe occur after 15-30
years causes lower lobe fibrosis Plural plaques are benign calcification in
hemidiaphrgm.
41.Bilteral infiltrates (hazy showading) in Chest X-ray + P02/Fi02 less than
200 + Low PCWP less than 18 + burn history is =ARDS
42.Causes of ARDs Infections :
Sepsis.
pneumonia,
Tuberculosis ,
uraemia
anaphylaxis
Burns
Pancreatitis
Trauma
43.Massive blood transfusion Smoke inhalation injury Cardiopulmonary bypass.
44.Pcwp in ARDs is less than 18mmhg while in Cardiogenic
pulmonary edema it's more than 18.
45.Treatment of ARDS
Mechanical ventilation with maximal ventilatory therapy Fi02 100%
PEEP 15cmH20 peak pressure 40cmH20
If still unresponsive(on maximum ventilatory therapy and still
hypoxia) Extracorporeal oxygenation (ECMO)
• 40
46. Progressive breathlessness + large amount of sputum
(bronchorrhoea)+ alveolar walls filled with mucin is =
bronchoalveolar
cell carcinoma
47.Dyspnoea + fatigue, weakness, syncope + left parasternal
heave + loud P2 + pansysytolic from TR + early diastolic murmur
is = Pulmonary arterial hypertension
48.Drugs associated with pulmonary arterial hypertension is
appetite suppressants, amphetamine.
49.. With GCS less than 8 and patient suffering from unprotected
airway = intubation fast bleep ETT and give high flow oxygen if he is
not chronic co2 retainer.
50. Acute exacerbation
pneumonia
Lung fibrosis,
pulmonary embolism
Causes of type2 respiratory failure are :
COPD,
acute severe asthma,
Ankylosing spondylitis,
Kyphoscoliosis
Treatment of type1 :High conc Oxygen(>35% usually 60%high flow 6-8L
Treatment of type2:Low conc(24-28%)Low flow (1-2L/min)
51.Type1 respiratory failure = Pao2=less
than 8 PaC02 =less than 6.6
Type2 respiratory failure =
Pa02<8PaC02=>6.6 (hypercapnia)
52.Causes of type 1 respiratory failure
are :
acute Asthma,
emphysema,
COPD + respiratory type 2 is
treated by NIV if there is no
contraindication to it if there is
contraindications then use
intubation ventilation.
53.Punemonia + high WBC + high inflammatory markers +
unilateral consolidation + pigeons is = Chlamydia psittaci
pneumonia
Treatment: tetracycline or macrolides
54.Shortness of breath + dry cough + fever + bilateral
basal inspiratory crackles + upper lobe fibrosis + IgG
precipitins is= Extrinsic allergic alevolitis
55.Lab in extrinsic allergic alevolitis (hypersensitivity
pneumonitis) :
Chest X –RAY : upper lobe fibrosis
BAL : lymphocytosis
Blood : NO Eosinophilia IgG precipitants
Saccharopolyspora in farmers lung No high IgE
No positive skin test
No antibiotic
Remember in hypersensitivity pneumonitis there
is bilateral findings on x-ray
56.Treatment of extrinsic allergic alevolitis Antigen
avoidance Oral steroids
57. Pigeons bird fanciers :avian proteins
Farmers lung : Saccharopolyspora rectivirguls
Malt workers lung: Aspergilus clavatus
Mushroom workers lung: thermophilic actinomyces
Bysinosis :textile industrial cotton hemp dust
Baggassosis: sugarcane
58.Spirometry in extrinsic allergic alevolitis is mixed.
59.Techypnae+techycardia+Low grade fever + sudden
onset chest pain + haemoptysis + normal chest x-ray is =
Pulmonary
embolism.
60.Lab in pulmonary embolism:
PE likely >4 points = Do CTPA if there is delay give LMWHPE
unlikely≤4 or less consider D dimer if positive then do CTPA
CTPA is contraindicated in renal impairment and contrast allergy
use v/Q scan
ECG:S1Q3T3,RBBB,right axis deviation ,sinus tachycardia
V/Q mismatch: pulmonary embolism , AV malformation,
Vasculitis ,COPD gives matched defect
Pulmonary angiography gold standard but complication
GASTROENTEROLOGY
&
HEPATOLOGY PEARLS
1.Truma / violet vomiting / endoscopic
procedure/ malignancy + shock + pain
+ left side pleural effusion + pleural
Fluid Exudative and high amylase +
ratio of pleural fluid amylase to serum
amylase >1 is = Oesophageal rupture
Diagnosis : radio logically with water
soluble contrast
Treatment : Surgical
2.Gastroenteritis : Empirical antibiotic
only indicated if systemically unwell ,
immunosuppresion,or elderly even if
patient has bloody Diarrhoea so give
oral rehydration solution otherwise
3.Patient taken metronidazole for 7 days
for Clostridium difficle and he is improved
and has no symptoms but yet stool shows
c.diffcle next step = Nothing needed
4.Investigation of choice for barret
oesophagus is = Endoscopic biopsy.
5.Management of barret oesophagus is :
No dysplasia + <3 cm of barret = endoscopy every 3
to 5 years with biopsies
No dysplasia+>3cm =endoscopy every 2 to 3 years
+ start PPI and repeat endoscopy and biopsy every
2 .
grade dysplasia = High dose PPI +every six monthly
biopsy.
High grade dysplasia = oesophagectomy +
photodynamic therapy and ablative therapy.
6.Isolated unconjugated hyperbilirubmina + normal
LFTS is = Gilbert syndrome
7.Jaundice in Gilbert is exacerbated by :
fasting,alchol,acute illness even like sore throat
also by ostrogen improved by low dose
barbiturates
8.Risk factors for barret oesophagus are :
Gerd
Male Stricture or ulcer Has increased risk of adenocarcinoma
Metaplasia of lower oesophagus when normal
squamous epithelium replaced by columnar epithelium
9.Investigations
in Gilbert syndrome are:
Rise in bilirubin provoked by prolonged fasting or IV nicotinic
acid.
10.Management
of Gilbert syndrome is :
No treatment required
If severe jaundice = Phenobarbitone
11.Non bloody Diarrhoea + young patient + weight loss +
abdominal mass palpable on right iliac fossa is = Crohn's
disease.
12.Complications
of Crohn's diseases are :
Gallstones oxalate
renal stones
Fistula
Anal tags
Mouth ulcers
Perianal disease
Episelritis
13.Lab in Crohn's disease are:
Histology : all layers trans mural ,High goblet cells ,Granulomas
Endoscopy : deep ulcer, skip lesion ,
cobblestone
Radiology : stricture : Kantor's string sign ,rose thorn
ulcers,
fistula, proximal bowel dilation
ASCA +P-ANCA –
14.Smoking worsen Crohn's but improves ulcerative colitis .
15.Management of Crohn's diseases:
Inducing remission : steroids (oral, rectal ,IV)
Azathioprine or 6 meracaptopurine add on
Methotrexate alternative to azathioprine
(Contraindicated in anaemia )
2nd line is steroids but not as affective as azathioprine
is 5ASA( mesalazine ) Refractory Crohn's = infliximab
IV Fistulating Crohn's = Infliximab
Perianal disease = Metronidazole
Diet in Crohn's : short term TPN,enteral feeding
elementary diet low fat medium chain TGA in diet
Lactose intolerance dairy free diet.
16.Crohn's disease in pregnancy is = steroids
P
E
A
R
L
S
17.Maintaining
remission in Crohn's disease :
No steroids
Stop smoking
Azathioprine or meracaptopurine is 1st line
Methotrexate 2nd line 5-ASA drugs(Mesalazine) if surgery has done.
18.Complications
of surgery in Crohn's disease:
1.bile salt Malabsorptive =bile acid diarrhoea with abnormal
14C glucolate test treatment : Cholestrayamine
2.Cholesterol gall bladder stones
3.urinary Cal oxalate stones and renal calculus
treatment : good hydration, dietary oxalate
restriction (cocoa, peanut tea coffee wheat germ
rhubarb spinach ,Cholestrayamine
4.pyoderma gangreosum.
19.Crohn's disease + surgery ileostomy +deep ulcer begin to
form skin round stoma = pyoderma gangreosum treatment
oral
steroids.
20.Depression+ sertraline use + Lymphocytes infiltration is
=
Lymphocytic colitis treatment is withdrawal of drug
Loperamide,Cholestryamine,Azthprine.
21.Young patient +bloody Diarrhoea + abdominal pain on left
lower quadrant is = ulcerative colitis
22 Investigation in ulcerative colitis :
Crypt abscess
Depletion of goblet cells
No Granulomas
Endoscopy : pseudo polyps
Radiology: loss of haustrations Colon narrow and short drainpipe
colon
P-ANCA + ASCA –
23.Most common site of ulcerative colitis = rectum
Most common site of Crohn's diseases=terminal ileum.
24.Management of ulcerative colitis : Inducing
remission: rectal topical 5ASA,oral ASA
2nd line = oral steroids
Servere colitis = IV steroids
Maintaining remission in ulcerative colitis
Oral 5ASA :
Mesalazine
Azathioprine or meracaptopurine
No Methotrexate here
25.Colorectal cancer UC > Crohn's
26.Mild to moderate Ulcerative colitis = sulphasalzine
Severe UC =IV steroids.
27.Side effects of sulphasalzine are :
Skin rashes
Oligospermia
Headache
Heinz bodies
Agranulocytosis
Pancytopenia
Stomatitis
Parotitis
28.Side effects of Mesalazine are :
GI upset
Headache
Agranulocytosis
Pancreatitis
Intestinal nephritis
29.Oligospermia
by sulphasalzine
Pancreatitis with Mesalazine >sulphasalzine
30.Investigation in IBD are :
Endoscopy is investigation of choice = ileocolonscopy
C -reactive shows disease activity
High faecal Cal protectin high in IBD (50)Normal faecal calprotecin make it less
likely
31.With use of infliximab and
azathioprine care of non melanoma skin
cancer should be kept in mind.
32.Crohn's like enterocolitis = Mycophenolate
mofetil.
33.Air bubbles on passing urine = Crohn's with
colovesical and fistula.
34.Ulcerative colitis : Mild :<4 stools per day, small
blood in
stool, no temperature ,pulse 90 hb : 9
anaemia, ESR 30 CRP:30
Moderate:4-6 stool per day, blood in stool mild to
severe ,no temperature, pulse 90,no anaemia ESR
30,CRP 30
Severe:>6 stool per day , visible blood,37.8 C
temperature pulse>90 anaemia <105g ESR>30
CRP>30
35.Most reliable sign in toxic megacolon = pulse rate.
36.Helpful investigation in toxic megacolon = X- ray
37.Treatment of choice in toxic megacolon = Colectomy
38.Best investigation in toxic megacolon
is = Flexible sigmidoscopy
39.Investigation contraindicated in toxic megacolon are :
Barium enema
Colonoscopy
40.Criteria for toxic megacolon :
>6 stools bloody per day
>37.8 C
HR>90
TLC neutrophils
>10Hb <10.5
ESR=>30
CRP >30
Dilated colon 6m
X-ray loss of haustrations and mucosal oedema thumb printing
42.Management
of toxic megacolon :
HDU + high dose IV steroids + rectal steroids + IV fluid
+ LMWH + cyclosporine (+infliximab + surgery + no
antibiotic
43.Treatment in Toxic megacolon :
1st IV steroids then Colectomy + cyclosporine if contraindicated then Infliximab
44.Toxic megacolon seen in : Ulcerative colitis mainly Pseudomembranous colitis,
Ischemic colitis
45.Precipating
factors for toxic megacolon are :
Low K
Low Mg
Under treatment
Nsaids
Opioids
Bowel perforation
Antidiarrheal
46.Total Colectomy in UC+ high stool + urgency + incontinence + nocturnal
sleepage is = pouchitis following ileal anal anastomosis
treatment : antibiotics metronidazole ciprofloxacin.
47.UC ≤ colorectal cancer :
Low risk : <5 years colonoscopy means extensive colitis but no active
Endo/histology exam ,left sided colitis
Intermediate:3year Colonoscopy : extensive colitis with mild to active
Endo histology exam, post inflammation polyps or family history in 1st
degree 50or over
High risk:1year follow up extensive colitis with moderate or severe
Endo histology Stricture Dysplasia
48.40-60 years + weight loss +Diarrhoea+ seronegative arthropathy +
stoarrhaoe + abdominal distension + seizures + myoclonus + ataxia +
Endocarditis + oculomastictory myoarthytitis + Valvular conduction
problems + anaemia + pleurisy is = Whipple disease by tropheryma
Whipple
49.Investigation in Whipple disease are :
Duodenal ,junjunal biopsy showing t.whipple with in PAS
stain
PCR DNA best diagnostic to detect remission after prolonged
therapy
50. treatment of Whipple disease :
Initial :IV penicillin and streptomycin for 2 weeks followed by
one year
of tetracycline and cotrimazole Cerebral involvement doesn't
treated
by antibiotics
51.Diabetes mellitus + hypogondasim loss of libido +
bronze skin pigmentation + arthralgia pseudo gout
chondrocalnosis + erectile dysfunction + heart failure +
Hepatocellular carcinoma is=Hereditary
hemochromatosis
52.Reversible
complications of hereditary hemochromatosis are:
Cardiomyopathy
Skin pigmentation
Hepatosplenomegaly and high liver enzymes.
53.Irreversible complications of hereditary hemochromatosis are :
Arthropathy
Ddiabetes mellitus
Liver cirrhosis
Hypogondasim
54.Investigation in Hereditary
hemochromatosis are :
General population: Transferrin saturation
>ferritin Family members:
HFE genetic testing chromosome 6.
55.Liver biopsy gold standard in Hereditary
hemochromatosis.
56.If transferrin saturation >45% warrants further testing
if <45% exclude dx If ferritin >1000 =liver biopsy.
57.Typical iron study in hemochromatosis:
High iron >30Low TIBC <20High ferritin
>500Transferrin saturation>55% in men
>50%in women.
58.Treatment of hereditary hemochromatosis :
Repeated venesection most cheapest effective treatment
Iron chelation with desferioximine
if venesection Liver transplantation
59.Upper GI endoscopy is useful for gastric cancer.
60.Liver biopsy is gold standard for hemochromatosis
CARDIOLOGY
PEARLS
11.Stopping smoking has greatest benefit
in reducing cardiovascular risk factors
2. ECG in ASD is
Ostium scandium = RBBB +Right axis deviation
Ostium premium =RBBB +Left axis deviation
3.. Pressure difference in aorta and left
ventricle is = Aortic stenosis
4.Myocardial infraction + low blood
pressure + systolic dysfunction +
cardiomegaly + upper lobe diversion is =
Cardiogenic shock
Treatment is diuretics and inotropes ,intra
aortic balloon pump
5.Complete heart block from inferior myocardial
infraction does not need pacing unlike CHB from
anterior MI
6. 1 to 6 weeks after myocardial infraction +
fever + pleurtic chest pain + pericardial effusion
+ friction rub + raised ESR is =Dresser syndrome
Treatment is aspirin Nasid ,If still resistant steroids
7. PCI is gold standard treatment in St elevation mi
with 12hrs
8. Blood pressure controlled by ACEi has greatest
effect on myocardial infraction.
9. High pressure in left ventricle + steep drop off
between LV and Aortic pressure is =HOCM
10.. High pressure in left Atrium + normal
pressure in left ventricle is =Mitral stenosis
11. High pressure in right ventricle +normal in
pulmonary artery is =Pulmonary stenosis
12. Difference gradient of pressure between left
ventricle and aortic pressure LV - Aortic pressure is =
Aortic stenosis
13. Cause of AS Younger patient less than 65years
= bicuspid aortic valve Older patients more than
65years= calcification
14. Features of severe AS
Narrow pulse pressure
Slow raising pulse
Delayed ESM radiating to Carotid
Soft or absent S2
S4Thrill
Duration of murmur
15.Treatment of AS if asymptomatic = Observe
symptomatic =Valve replacement
If asymptomatic but gradient more than 50 and features of LV
dysfunction is = Surgery Before valve replacement do coronary
angiography t o rule out coronary a disease, Transcather aortic valve
implantation if previous dement inoperable due to comardites
Pregnancy with symptoms = Porcine valve replacement
16. Drugs decreasing incidence of coronary events are:
Antiplatelet
Beta blockers
ACEi
Gemfibrozil
17. Worst prognosis of carcinoid syndrome is = Valvular heart disease
18.. Right heart failure + Ascites + pericardial calcification on x-ray +x
and y descent + kausmual breathing is = constrictive pericarditis
Treatment is with antiTB, Steriods if not then pericardectomy
19. Normal response of exercise tolerance is
=increase in BP and increase in Pulse
20. Treatment of SVT
Vagal manoeuvres ,Carotid sinus massage
contraindicated in carotid vascular disease IV
adenosine 6 mg then 12mg contraindicated in
Asthma use verapamil
21. SVT + asthma = give verapamil
22.Preganacy + SVT = Adenosine
Prophylaxis = beta blockers and verapamil avoid BETA
BLOCKERS in 1st trimester
23.Streptococcal bovis + infective endocarditis do=
Colonoscopy
24.Post valve surgery less than 2month common
cause of infective endocarditis is = staphy
epidermis Post valve surgery more than 2 month
cause of infective endocarditis is = Staphylococcus
areaus
25.I/V drug user cause of infective endocarditis
= Staphylococcus areaus
26.In dental procedure most common cause of infective
endocarditis is = Strep Virdnas
27. Bowel resection common cause of endocarditis is =
Bacteriods
28.Useful lab test monitor treatment of Infective
endocarditis is =C reactive protein
29. ECG of LVH =R wave in V5 or V6 plus S wave in V1 or V2
exceeds 35mm
30.1st line treatment in chronic heart failure is =ACEI and BB
2nd line =Aldosterone antagonist ,ARB , hydralazine nitrates.
31.Drugs improve mortality Heart failure are:
ACEi ,
Beta blockers,
Spironolactone ,
Hydralazine with nitrates
32.Indications of IvAbradine:
Ejection fraction less than 35%
When medical therapy has failed
HR more than 75 NYHP class 2
33. Indications of cardiac resynchronization in Heart failure are :
QRS more than 150ms with LBBB
Ejection fraction less than 35
NYHP class 3,4
34.Indications of ICD
QRS 120-149 but no LBBB
Ejection fraction less than 35 symptomatic heart failure .
35. Indications of anticoagulant in Heart failure:
Previous thromboembolic event.
Intrathoracic cardiac thrombus
Left ventricular aneurysm
36.INR more than 8 +no bleeding /minor bleeding =stop
Warfarin +give Vitamin K 2.5 to 5mg Give warfarin once INR
is less than 5
INR 5-8+no bleeding =stop warfarin
INR 5-8+minor bleeding=stop Warfarin +give Vitamin K
1-2.5mg and restart warfarin once INR is less than 5
37.Treatment of heart blocks 1st degree =no treatment
2nd degree type 1 mobitz wenckenbach =
asymptomatic Discharge With
symptoms=permanent pacemaker Type 2=
transvaneous cardiac pacing
Complete heart block=permanent pacemaker
Temporary transvaneous pacing
38.Atropine is not useful in type 2 block and complete heart
block
39.1st degree block= prolong PR more
than 0.2
2nd degree type 1=progressive prolongation if PR
interval until dropped beat
Type 2=PR interval constant but P is not fallowed by
QRS
Complete heart block=no association between P wave and
QRS
40.Patient having chest pain exercise but not on
rest next step = do coronary angiography
41. Holter mentoring is used for rhythm disorder
42. Stress exercise tolerance are used when
aetiology is not clear and ECG is not diagnostic
43.If you can't read ECG in stress test then use
thallium scan or Echo detection of wall motion
44.If patient can't exercise then use
Dipyridamole with thallium scan it
Dobutamine with ECHO
45.3 vessel disease or 2 vessel disease in diabetes
needs CABG 1 or 2 vessel disease needs stent
placement
46.Arterial fibrillation + Valvular disease is = Give
Warfarin
47.Arterial fibrillation + Stroke or TIA = Give warfarin
48.. Arterial fibrillation + CHADS score zero = No treatment
49.Pharmacological cardio version If no structural heart disease =
Flecainde
If structural heart diseases = Amiodarone
50.Factors favouring heart rate control in Arterial fibrillation:
i. older than 65 years
ii. History of ischemic heart diseases
51.Factors favouring rhythm control in Arterial fibrillation :
i. younger than 65 years
ii. symptomatic
iii. 1st presentation, alone AF or AF secondary to precipitant like
alcoholic,. CHF
52.Indications of DC cardio version in AF are:
i. Blood pressure less than 90 mmhg
ii. chest pain
III. heart failure
iv. impaired consciousness.
HR more than 200
53.. Don't use rhythm control in asymptomatic Arterial fibrillation patients
nor in patients with permanent Arterial fibrillation.
54.Don't use antiplatelet for stroke prevention in Arterial fibrillation
55.History of Arterial fibrillation + enlarged left atrial size with previous DC cardio
version the best long term treatment will Arterial fibrillation ablation
56.Drugs to avoid in Hypertrophic obstructive cardiomyopathy are: AIN
A=ACEI,
I= inotropes
N=Nitrates
57. Young patient + dyspnoea + angina +s syncope + jerky pulse + double
Apex beat + pulus bisfergens is = Hypertrophic obstructive cardiomyopathy
58.Ecg in Hypertrophic obstructive cardiomyopathy is:
i. LVH
ii. T wave inversion
III. deep Q wave
iv. Right bundle branch block
V. PR prolongation
59 .Treatment of Hypertrophic obstructive cardiomyopathy is ABCDE
A= Amiodarone
B= Beta blocker if Contraindicated then verapamil
C= Cardioverter defibrators
D=Dual chamber pacemaker
E= Endocardial prophylaxis
60. When to use ICD in HOCM=,
Patients who survived a cardiac arrest due to VT,VF who has sustained VT
causing syncope or haemodynamic compromise .
NEPHROLOGY
PEARLS
1. Azathioprine is associated with increased risk of
non melanoma skin cancer
2. Renal angiogram investigation of choice for PAN
3. 1st line treatment for Raynaud phenomenon is CCB nifidipine
If severe ulceration give prostacyclin iloprost infusion
4. Steroid use is known to precipitate scleroderma renal crisis
5. Mainstay treatment for oxalate stone is =High fluid
intake and calcium carbonate
6. Investigation of choice for renal stones is = Non contrast Ct scan
In pregnancy =ultrasound
7. IgA nephropathy occurs after 1 to 2 days for upper
respiratory tract infection VS post streptococcal
glomerulonephritis which occurs 7 -14 days following
group A streptococcal infection
8. Alcoholic + haematuria =IgA nephropathy
9. Main treatment of igA nephropathy is observation
If proteinuria less than 3 then use ACEi
If Proteinuria more than 3 then use Steriods
10. Young patient with hypertension + abdominal
pain + haematuria + recurrent urinary tract infection
+ normal hb + ultrasound shows cysts in kidney is =
Autosomal polycystic kidney disease
Treatment is = fluids and symptomatic
tolvaptan for decreasing annual rate of kidney growth 11.
11.Hematuria shoes cyst rapture
12. Loin pain shoes infection of cyst haemorrhage
13 . Palpable purpura limbs, buttocks +
abdominal pain + haematuria and Proteinuria +
arthritis + IgA deposit is = Henoch schonlein
purpura
14. All patient with Hypertension and Proteinuria
more than 1g per day should be given ACEI
15.Weight loss + neurological impairment on
long standing dialysis +joint pain and stiffness
in upper limbs = Amyloidosis AL amyloid =
Myeloma ,waldenstrom , MGUS + cardiac ,CNS
involvement, macroglossia, perioribital
ecchymosis
AA amyloid=TB, bronchiectasis,
15 .B2 macroglobulin on renal dialysis
16. Loop diuretics causes calcium stones Thiazide diuretics prevent it.
17. Fever + rash + arthralgia + eosinophilia + eosinophuria
(pathognomonic) + nonoliguric renal failure + no eosinophilia
with NSAID + Proteinuria + mononuclear infiltrate in
intersium is =Acute interstial nephritis
Treatment is drug withdrawal and steroids
18 . Long standing dialysis + Renal failure + CNS
abnormalities + joint pain and stiffness in upper limb
more than lower limb +beta 2 microglobulin is=
Amyloidosis
Treatment with Renal transplantation
19 . Haematuria + Loin pain + Abdominal mass + anaemia +
Hypertension + polchythemia + left varicocele is = Renal cell
carcinoma
ultrasound is investigation of choice
Treatment for confined disease is partial or total
nephrectomy For advanced is tyrosine receptor
inhibitor sunitinib >sorafenib
20. Hodgkin lymphoma =minimal change disease
Non Hodgkin lymphoma =Membranous Glomerulonephritis
21. Malignancy + nephrotic range Proteinuria + IgG ,C3 deposition
+ Spike and dome appearance is =Membranous
Glomerulonephritis
treatment = combination of cyclophosphamide and
methylpredinsone
22. Pulmonary haemorrhage , haemoptysis + fever,
haematuria + Proteinuria, red cell cast + linear ig G deposit +
increase Dclo + antiGM antibodies is=Good pasture
syndrome
Treatment with iv methylpredinsone cyclophosphamide
In severe cases plasmaphresis
23. Nephrotic range Proteinuria + raised creatinine + normal
sized kidney s on ultrasound scan + focal segmental
glomerulonephritis + normal BP+ raised
immunoglobulins,raised cholesterol is=HIV nephropathy
24. Treatment for high phosphate in end stage renal
failure is =Sevalmer Hyperparathyroidism + dialysis =if
surgery is not option use cinacalcet
25 Loin pain + peripheral leg oedema + acute renal injury +
Proteinuria is =renal vein thrombosis
Treatment is life long warfarin
26. Opioid of choice in syringe driver renal failure is =Alfentanil
27 Kidney transplant recipients have high risk of
developing non melanoma skin cancer
28 . Collapse/seizure/ ecstasy /coma/fall + acute kidney
injury +High P, High uric acid , High K , High Ck , low calcium
is = Rhabdomylosis
Treatment is IV fluid
29. All patients with diabetes and microabluminuria should
be offered with ACEI or ARBs irrespective of whether they
have hypertension
30 . Indication of iron therapy in CKD anaemia
i) ferritin level less than 100
ii) transferrin saturation less than 20 Percentage then
give iv iron and when there is functional iron
defienancy i.e. transferrin saturation less than 20% Give
oral iron
when there is no functional iron defienancy i.e.
transferrin saturation more than 20
31 CKD +high calcium +high phosphate +high PTH
is =tertiary hyperparathyroidism
Treatment is 1st line Para thyroidectomy
If unfit for surgery then cinacalcet
32 . Bilateral sensorneural deafness + corneal
dystrophies, lens abnormalities, retinitis pigmentosa +
microscopic,marcoscopic haematuria with or without
Proteinuria + foam cells , basket wave pattern glomerular
basement membrane is = Alport syndrome
33. Children/young adults + nephrotic syndrome +
selective Proteinuria + normal Blood pressure + history of
Hodgkin's lymphoma\ Nsaid use/gold/
lithium,rifamicin/+normal looking glomeruli on light
microscopy or fusion of podocytes on electron microscopy
is =Minimal change disease
Treatment is steroids if resistant then use cyclophosphamide
34 . Urine sodium more than 30 +fraction of sodium excretion
more than 1+ urea level more than 35 + urine osmolality less
than 350 + brown granular casts +no response to fluid is=
Acute tubular narcosis
36 . Marked loss of subcutaneous tissue from face + low
c3 level+ linear intramembranous deposit is =
Membranoproliferative GN type 2 Lipid lipidystrophy
37 Nephrotic syndrome Proteinuria or haematuria +
low C3 + sub endothelial immuno complex deposit
,thickening and splitting capillary membrane
+hepatitis C /Cryoglobulimia is
=Membranoproliferative GN type 1
Treatment is steroids
38 Antibiotic for peritoneal dialysis peritonitis is =
Intraperitoneal vancomycin and gentamicin
39. 1st choice for vascular access for dialysis is =
Arteriovenous fistula
40. Short of breath + cough productive of fresh
blood + Proteinuria + haematuria + PANCA,CANCA
is=microscopic polyangitis
41. Asthma + eosinophilia + renal failure +pulmonary
haemorrhage + sensory neuropathy + PANCA is = Chrug Strauss
syndrome
42 . 1st line treatment in secondary hyperparathyroidism is
=Calcium acetate
43 . Flush pulmonary edema + urinalysis worse on ACEI /ARBs +
asymmetrical kidney is = renal artery stenosis
44. Investigation of choice for renal artery stenosis is = MR
angiography
45 . Renal artery stenosis 1st line is medical therapy
In fibro muscular dysplasia 1st line is angioplasty
46. Infancy/early childhood + recurrent urinary tract infection
+small shrunken scared kidneys + Hypertension is =Reflux
nephropathy/chronic pyelonephritis
Investigation of choice is excretion urography (micturating
cystouthrogram)
47. Normotension + alkalosis + hypercalciuria + hypokelmia
+ high urinary chloride + high urinary sodium +high renin
and aldosterone + hyponatremia and hypochloremia +
hyperplasia of JG apparatus is =Barter syndrome
Treat with spironlectone,nsaids
48.Normotension+hypokelmia+hypomagnesmia+hypocalc
uria+metaboli c alkalosis+ =Gittleman syndrome
Treatment is spironlectone,nsaids
49. Hypokelmia + hypertension + low renin and
aldosterone is = Liddle syndrome Treatment is amiloride
but not spironolactone
50.. Low sodium +low k + normal urinary sodium and
potassium is = Diuretics abuse
51 . [Renal transplant patient + sudden deterioration in
renal function + 7 -21 days after + biopsy shows
lymphocytes is = Acute cellular rejection
Treatment with IV bolus of high steroids
52 .Renal transplant patient after 4 weeks + gradual rise
in creatinine +pneumonitis , colitis ,oseophgitis +
neutropenia is = Cmv infection
Treatment give ganiclovir
53 .Young woman +hypertension + high renin +high aldosterone is
=Fibro muscular dysplasia
54.Urinary retention + catheter than pass urine
+enlarged prostate is =obstructive uropathy
55.In renal transplant irradiated type of blood is
indicated for blood transfusion
56.Angioplasty/ warfarin /CABG+ eosinophilia +
Proteinuria+ purpura + livedo reticularis + low C3 + high ESR
is=Cholesterol embolization
57. treatment of Renal cell carcinoma + solitary brain
metastases is = nephrectomy + tyrosine kinase
inhibitor Chemotherapy and radiotherapy has no role
in renal cell carcinoma
58.Factory /rubber/printing/
cyclophosphamide + microscopic haematuria
+terminal dribbling + feeling to empty bladder
is = transitional cell carcinoma of bladder
Treatment for localized tumours is transurethral tumour
of resection use of intravesical chemotherapy
59 .Investigation of choice for bladder cancer is =cystoscopy
60.Haematuria + Loin pain + Abdominal mass + anaemia +
Hypertension + polchythemia + left varicocele is=Renal cell
carcinoma
ultrasound is investigation of choice
Treatment for confined disease is partial or total nephrectomy
For advanced is tyrosine rec inhibitor sunitinib more than
sorafenib
HAEMATOLOGY
PEARLS
1.Beta 2 microglobulin shows the prognosis in
multiple Myeloma
2.Absence of erythroblast + anaemia + normal WBC
,platelets + absent reticulocytes + high iron and ferritin +
antibodies to erythropoietin is=pure red cell aplasia
Treatment is discontinuation of EPO and repeated transfusion
3. Venous/ arterial thrombosis + recurrent fetal loss +
livedo reticularis + low platelets +prolonged APTT ( fails
to correct with addition of normal human plasma )
History of SLE + lupus anticoagulant + anticardiolipin
antibodies is = Antiphospholipid syndrome
4.Treatment of Antiphospholipid syndrome :
Venous thrombosis= Warfarin with INR 2-3 for 6 month
Recurrent venous thrombosis= lifelong warfarin : if occurred
while taking warfarin then increase INR to 3-4
Atrial thrombosis= lifelong war
farin target INR 2-3
5. Treatment of Antiphospholipid syndrome in pregnancy is = Aspirin +LMWH
6. Causes of Extravascular haemolysis : WAHH:
WA-warm Autoimmune
H- hereditary spherocytosis
H- Heamoglobinopathies i.e. Sickle cell,thalesmia H-
Haemolytic disease of new born
7. Warm autoimmune haemolytic anaemia has = IgG
8.Cold Autoimmune haemolytic anaemia has = IgM
9. Causes of warm autoimmune haemolytic anaemia are :
Autoimmune disease=SLE
Neoplasia : Lymphoma, CLL
Drugs: Methyldopa, penicillin, cephalosporin, levodopa,Nsaids,Quindine (treated by stopping
drugs + oral Prednisolone)
10. Causes of Cold autoimmune haemolytic anaemia are : Neoplasia: Lymphoma Infections
:Mycoplasma ,EBV ,legionella , malaria
11.Treatment of autoimmune haemolytic anaemia: Warm: steroids
immnosupression,spelnectomy
Cold : respond less to steroids
12.Anemia+jaundice + splenome
galy +
retic count more than 3 is = haemolytic anaemia
13.Features of intravascular haemolytic anaemia : Heamoglobinuria Low hepatoglobin Haemosiduria High LDH
Heamoglobenimia
14. Direct Combs test is diagnostic for haemolytic anaemia 15.
Treatment of Myelofibrosis : 1st line: hydroxycarbamide
interferon A and Bone marrow transplantation
16.Diagnostic test for Myelofibrosis is trephine bone marrow biopsy
17. 50 -60 years + fatigue + massive splenomegaly + weight loss , night sweats + tear drops
poikilocytes + high WBC + high Platelets (initial) + dry tap + high LDH + Jak2 + large abnormal
platelet + portal HTN is = Myelofibrosis
18.History of treatment chemotherapy for High grade lymphoma/ leukaemia + high K + High
Phosphate + high uric acid + low Calcium + kidney injury (high creatinine ) is = Tumour lysis
syndrome
19. Prevention of tumour lysis syndrome:
Low risk : Hydration (IV fluids) + Allopurinol
Intermediate risk: Allopurinol for 7days + IV fluids
High risk : (high tumour burden, rapid turnover, renal impairment,age,drugs) Rasburicase +
IV fluid
20. Never combine Rasburicase with Allopurinol when treating tumour lysis s
yndrome
21. Haematological disorders associated with Down syndrome are :
Fanconi's anaemia
Aplasia
AML
ALL
22. Abdominal pain + peripheral neuropathy (low radial pulse,wrist drop + constipation +
blue lines on gums + lead level more than 10 + microcytic anaemia + basophilic stipling +
high serum or urine level of Delta aminolevulinic acid + high urinary level of coporpohyrin
other normal is =Lead poisoning
23. Treatment of lead poisoning : DMSA for
chronic poisoning
EDTA for acute poisoning D penicillamine Dimercarpol
24. Purpuric rash + isolated thrombocytopenia +
normal PT + normal APTT + high bleeding time +
coombs positive + IgG antibody + Megakaryocytes
on bone marrow exam is = idiopathic
thrombocytopenic purpura
Investigation is = Blood film exam.
25. Treatment of ITP Asymptomatic = Observation
platelets more than 30000 + no bleeding = Observe
Platelets less than 30000 + mild bleeding = Oral Prednisolone
Platelets less than 30000 after 3 minutes of
steroids therapy = Splenectomy
Severe bleeding (GI,CNS) + Platelets less than 10000 = IVIG
If Splenectomy ineffective = Rituximab, azathioprine
cyclophosphamide
26. ITP + autoimmune haemolytic anaemia is = Evan's
syndrome
27. Massive painle
ss ly
mphadenopathy in young person next step is to Lymph node biopsy
28. Avascular necrosis of hip + hand foot syndrome + dacylitis is = thrombotic crisis
29. Acute chest syndrome + stroke is= sequestration crisis Stroke in it treated by Exchange
transfusion
30. Sudden fall in haemoglobin without appropriate increase in reticulocytosis + infection by
parvovirus is =Aplastic crisis
31. Treatment of sickle cell anaemia :
Analgesia : opiates, Rehydration
Oxygen Exchange transfusion if CNS complication Avoid iron therapy and intraartucular
steroids
For preventing and acute complication use hydroxyurea
32. Osteomyelitis in sickle cell is caused by salmonella
33. Investigation for sickle cell anaemia is :
Sickle cells
Target cell Metabisulite screen Hb electrophoresis HbAs sickle cell trait protective against falciparum
malaria[
34. Poor prognostic factors in
AML
I) Cytogenetic Deletion chromosome 5 or 7
ii) age more than 60 years
iii) more than 20% blasts after first course of chemo
Iv ) 3q26 aberrations
35.20 years + DIC + low platelets + Auer rods + t 15:17 is = APML M3
Treatment is All trans retinoic acid ATRA plus Anthracycline
36. Treatment of AML
Initial: Cytarbine and Anthracycline Bone marrow transplantation
37. M2:AML with maturation=most common t(8:21)
M3 acute Promyleocytic :t (15:17) ,DIC
M4:acute myelomonocytic inversion 16
M5:monocytic :Gum organomegaly lymphadenopathy
M7:megakarytotic :down syndrome in children less than 3 years and Myelofibrosis
38. Good prognostic factors in AML
i) Promyleocytic leukaemia M3
ii) t (8:21) and t(15:17)
iii) inv 16
39.
15-
59
years + marowfailure +gum
infiltration + hepatosplenomegaly + Auer rods myeloperoxidase positive +
sudden black positive is = AML
40.Indications of treatment in CLL
i) L
ymphocyt
es doubling time of less than 6 months or more than 50% increase
over 2 months
ii) bone marrow compromise anaemia, thrombocytopenia , neutropenia
iii) autoimmune complication : ITP, autoimmune haemolysis
iv) B symptoms (weight loss or Night sweats , fever more than 38 for more than 2
weeks)
v) massive more than 10 cm or progressive lymphadenopathy
vi) massive more than 6cm or progressive splenomegaly
41. Immunotyping is investigation of CLL B CD19 postive,CD5, CD23 flow
cytometry smudge cells
42. Poor prognostic factors in CLL
i) male sex
Ii) age more than 70 years
iii)lymphocytes count more than 50
iv) prolymphocytes more than 10% of blood lymphocytes
iv) Lymphocytes doubling time less than 12 months
vi) raised LDH vii
) CD38
positive
viii) chromosome del 17Good prognosis is chromosome 13 del
43.Treatment of CLL FCR :
Fludrabine,chrombicile or cyclophosamide,
Rituximab 1st line: Chlorambucil
2nd line Fludrabine : give cotrimazole as prophylaxis to prevent pumocytitis jirvociIbrutinib when FCR
ineffective
40-50 years + anaemia , weight loss + massive splenomegaly + low LAP + left shift
leucocytosis + high Platelet + high basophils + Philadelphia chromosome 9:22 is =
CML
o Philadelphia chromosome t(9:22) has good prognosis in CML Poor in AML+ALL
o Treatment of CML
1st line = Imatinib Hydroxyurea
Interferon alpha
Bone marrow transplantation
47. Thrombocytopenia + micro vascular haemolysis (normocytic anaemia, high LDH,
increased Indirect bilirubin, schistocytes )+ CNS signs + Renal impairment + Fever is
Thrombotic thrombocytopenic purpura
48 Treatment of TTP
o Plasma exchange is first line
o Steroids after plasma exchange completed
49.Causes of TTP
Post infection : urinary or GI (E coli 0157 )
Pregnancy
Drugs : Cyclosporine, OCP , penicillin,metraonxole, clopidogrel, Acyclovir
50. Lab of TTP:
Schistocytes
Coombs negative
Patient APTT normal
Bleeding time prolonged
51. Lupus anticoagulant does not correct when patient plasma is mixed with
normal plasma Factor VIII defiency correct more than 50% with Normal plasma
52. Factor VIII defienancy, Factor IX defiency , Vonwillbrand disease These all correct
with Mixed with normal human plasma
53. Factor VIII inhibitor also don't correct with human plasma like lupus
anticoagulant
In VIII inhibitor correct APTT with initial 50:50mix but when you repeat APTT it
doesn't correct
54. Male African , mediaterian, + sudden anaemia and jaundice + Heinz bodies,
bite cells + low enzyme level + high reticulocytes count is=G6PD defiency
55. Causes causing Haemolysis in G6PD:
PCS: P :Promaquine
c:ciprofloxacin, chloramphenicol
S: sulphonamides,sulphasalzine, sulfonylurea,
Quinidine, nasid aspirin vitamin K probencid nitrofurantoin Fava beans
56. Methamemoglobinemia in G6PD patient TREATED by Exchange transfusion
57. Normocytic anaemia + family history gallstones is = hereditary spherocytosis
58. Jaundice + splenomegaly + family history + gallstones + acute abdomen is = Hereditary
spherocytosis
59. Lab in Hereditary spherocytosis:
High MCHC
High reticulocytosis
Most accurate is eosin 5 meleimide
Osmotic fragility test
Osmotic gradient
ekatacytomrtry different target between hereditary spherocytosis and Hereditary
stomatocytosis
60. Treatment of hereditary spherocytosis:
Folate replacement
Splenectomy :best av
oided unti
l at least 6yeras of age to reduce risk of post Splenectomy sepsis
ENDOCRINOLOGY
PEARLS
1.High oestrogen + high progesterone + low
LH,FSH + high prolactin + high Beta HCG is =
pregnancy
2.Normal oestrogen + high testosterone +
LH high + FSH normal + high FSH and LH
ratio is = Polycystic Ovarian syndrome.
3.Low oestrogen + high FSH,LH is = premature
ovarian failure
Treatment : hormone replacement.
4.Normal oestrogen + high FSH and LH is =
resistant ovary Syndrome.
5.Elevated LH and testosterone with normal FSH =
Polycystic Ovarian syndrome.
6.Testosterone >7 + hirutism + virilisation +
deep voice + ciltromegaly is =Adrenal or
ovarian tumour.
7.Tall + lack of secondary sexual characteristics + Gynaecomastia + low testosterone
+ high LH FSH + firm small tests is = Klinefilters syndrome
8.Investigation in Klinefilters
syndrom
e:
Low testosterone
High LH FSH
Karyotype 47,XXY,47XX
Low HDL cholesterol
high TGA
Most appropriate test is FSH LH level.
9.Treatment of Klinefilters syndrome =Testosterone to
improve bone minerization
10.Anosmia + delayed puberty + low Testosterone, low
FSH,LH +
normal height + Cryptorchidism + hearing
defects/cleft lip plate visual defect + primary
amenorrhea + no mental retardation is
=Kallman's syndrome
11.Investigation in Kallman's syndrome :
Diagnostic test is FISH MRI =absent olfactory bulbs
Low testosterone and low FSH LH
12.Treatment of Kallman's Syndrom
e is : ulses not continuous GnRH
Once family is completed then testosterone.
13. Klinefilters syndrome = Low testosterone + raised LH and FSH
Kallman’s Syndrome = Low testosterone + Low FSH and LH.
14.Primary hypogondasim ( Klinefilters syndrome ) = High LH + Low testosterone.
Hypogondotrophic hypogondasim (Kallman’s Syndrome ) =Low LH and FSH + Low testosterone .
Androgen insensitivity syndrome =High LH + Normal / High testosterone.
Testosterone secreting tumour = Low LH + High testosterone.
15.thyrotoxicosis
+ goitre + Autoantibodies + thyroid eye disease is =Graves disease .
16. 5 hypo’s in Addison’s disease:
Hypotension (postural )
Hypoglycaemia
Hyponatremia
Hypo aldosterone
HypoPH
17. 2 HYPER in Addison’s disease :
Hyperkalaemia
Hyperren
inemia .
18.Patient of Addison’s disease who
undertaken strenuous activity should double
their dose of glucocorticoid and
mineralocorticoids .
19.lethargy , weakness + anorexia + nausea ,
vomiting + weight loss + hyperpigmentation at
palmer or buccal mucosa + loss of pubic hairs +
hypotension + high K + Low sodium is =
Addison’s disease
20.treatment
of Addison’s disease is :
Hydrocortisone 100 mg IV TDS.
Fludrocortisone for postural drop
21. In Addison’s disease there is low T4 and high
TSH so never treat thyroid problems treat
Addison’s
thyroid will become normal .
22.treatment of thyroid overdose is :
Propranolol
Plasmaphresis in severe cases.
Cholestrayamine.
23. Investigation in Addison disease:
ACTH stimulation test(short synacthen test) After giving syn
acthen
of 250ug normally there increase cortisol of greater than 550 if below this confirm
diagnose of adrenal insufficiency to dx localize it we do long synacthen test where if
cortisol raise then it's secondary adrenal insufficiency if not then it's Primary.
24.Other tests in Addison’s diseases :
Adrenal autoantibodies anti21 hydroxylase Ab
9am cortisol and ACTH test low Cortisol and high ACTH
Metabolic acidosis
Macrocytic anaemia pernious
Blood: high Eosinophila,lymphocytosis , neutropenia mild hypercalcemia.
25.Causes of Addison’s diseases:
Autoimmune (most common)Infections TB = do CT abdomen showing shrinkage
of adrenals
Hiv
Cmv
Antiphospholipid syndrome (Hughes syndrome)
Waterhouse
fried
ache syndrome Metastasis (bronchial breast kidney)
26. Female patient with history of recurrent DVT and confirmed hypoaldostrone low
sodium high K positive short synacthen test is = Antiphospholipid syndrome ( Hughes
syndrome)
27.Sepsis / surgery/ steroid
withdrawal/infection + hypotension +
hypothermia + syncope + convulsions +
hyponatremia + hyperkalaemia +
hypoglycaemia is = Addisonian crisis
28.Treatment=IV fluids IL normal saline and
steroids IV hydrocortisone 100mg of IV
Dexamethasone
29.Tiredness Lethargy + postural Hypotension +
high ESR
o DIC + purpura + hyponatremia
high K is =Waterhouse fridirch
syndrome Treatment=IV fluids
and IV hydrocortisone
30.Low ACTH + no skin pigmentation + no
hyperkalaemia
BP normal + low Cortisol +
normal aldosterone is =
secondary hypoadrenalsim
Treatment : only glucocorticoid.
31.Cortisol curve can be used to asses how
appropriate dosing of glucocorticoid steroids
in Addison patient.
32.Expothalmus + diplopia + conjunctival oedema + opti
c disc
swelling + opthalmoplegia + inability to close eye lids lid lag lid retraction +
eu,hypo,hyperthyroid is =Thyroid eye disease.
33.Management of Thyroid eye disease :
Stop smoking
Stop Radioiodine
Use topical lubricant
High dose steroids
Orbital decompression
In replased or active disease = Radiotherapy
Malignant exophthalmos,,= steroids
34.Referral to Ophthalmologist in Thyroid eye diseases:
Unexplained sudden deterioration in vision
Change in intensity or quality of colour
eye pooping out globe subluxation
Corneal opacity
Optic disc swelling
35. Thyrotoxicosis + goitre + autoantibodies + Thyroid eye disease is = Graves
disease
36.Specific features in graves but not in other causes
of thyr
otoxicosis
Eye signs (30%) exophthalmos, opthalmoplegia
Pretibial myxoedema (most specific)
Thyroid bruit
Thyroid acropacy.
37.Investigation in graves disease
AntiTSH receptor stimulating antibodies (thyroid stimulating immunoglobins)(specific)
Anti thyroid peroxidase TPO antibodies
Increased level of SHBG
Globally increased uptake on thyroid scanT4,T3 high but T3 more specific.
38.Treatment
of graves disease:
Propranolol block adrengenic initials
Carbimazole 40mg for 12-18 Mon block thyroid peroxidase SE: agranulocytosis ( sore throat)
Treatment : stop drug start PTU once neutrophils recover Carbimazole should be stopped when
neutrophils less than 1.5Infection :
antibiotic (cephalosporin)G-CSF Erythromycin increase it's
activ
ity
Definitive treatment of thyrotoxicosis is Radioiodine only indication is
toxic multinodular goitre and single toxic adenoma Surgery.
39.Contraindications to Radioiodine therapy : Pregnancy avoid at least 4-6 Mon and breast feeding
Age less than 16yearsThyroid eye diseases
40.Indications for Surgery total Thyroidectomy:
Large goitre compression
Symptoms Intolerant to drugs.
41. Side effects of thyroid surgery:
Transient hypoparathyroidism
hypocalcaemia
Tetany
Infections
Bleeding Superior laryngeal nerve palsy
Permanent recurrent laryngeal nerve plasy
42.Gold standard test for diagnosis of growth hormone defiency is = Insulin tolerance test
insulin induced hypoglycaemia = GH response of less than 9mU/L when it is contraindicated
(Epilepsy)
use Alginate or glucagon test
Treatment: replacement therapy with biosynthetic human GH[
43.Weight gain + intermittent sweating + hypoglycaemia (feel hungry sweaty tremors diplopia
weakness ),+ early in morning or just before meal + high insulin + high c peptide + high proinsulin
:insulin
ratio is = Insulinoma
treatme
nt: s
urgery
If not fit for surgery : Diazoxide and somatostatin
4
4
.
R
a
d
i
o
i
o
d
i
n
e
t
h
e
r
a
p
y
s
h
o
u
l
d
be avoided 8 weeks following CT contrast.
45.Investigation in Insulinoma:
Supervised , prolonged fasting (up to 72 hours)
CT pancreases 90%are less than 2cm in size.
46.High insulin + high C peptide + high proinsulin
+ normal SU level = Insulinoma High insulin + high
C peptide + high SU level is= sulphonylurea
overdose High insulin + low C peptide =
Exogenous insulin or insulin misuse
Low insulin + low C peptide is = non beta cell tumour
47.Causes of hypoglycaemia less than 60mg/dl:
Insulinoma
Self administration
insulin/ sulphonylurea
Liver failure
Alcohol
Addison disease
48.sweating + confusion + headache + hunger + tremors + diplopia =
Hypoglycaemia
49.Treatment of hypoglycaemia :
Patient is conscious = oral glucose
Patient is unconscious = 50ml of 50%Dextrose water , IV Glucagon
50. Type 2 DM + bilateral Quadriceps w
asting
weakness + diminished knee reflex (LMNL)+pain in hip buttock and thigh burning pain at night +
ankle reflexes preserved and planters could be extensor or flexor + EMG Multifocal denervation in
paraspinous and leg muscles is = Diabetic amyotrophy
Treatment :resolves with improved glycaemic control and drugs 94
51.Hyponatermia + urine sodium more than 20 + low plasma osmolality less than 270 + high
urine osmolality more than 1000 or more than 300 is = SIADH
52.Causes of SIADH are :
Cancer : small cell lung cancer, pancreatic and prostate
CNS : stroke, subarachnoid haemorrhage, subdural haemorrhages,
meningitis/encephalitis/abscess
,head injury/neurosurgery operation, Infections : Tuberculosis pneumonia
Drugs: Sulphonylurea, SSRI , TCA,. Antipsychotics (Haloperidol,quetapine , clozapine
Carbamazepine Thiazide , Vincristine, Cyclophosamide, Omeprazole Other: positive end
expiratory pressure (PEEP) Porphyria
53.Treatment of SIADH :
1st line : Fluid restriction (750-1000)
ADH V2 receptors antagonist = tolvaptan Demeclocycline :reduces responsiveness to ADH
used In refractory cases
Hypertonic saline in
severe case like fits Slowly correct sodium other CPM
54.T scores > -1 =Normal
score b/w -1 to -2.5 =osteopenia T
score less than -2.5=osteoporosis
55.Lady with hysterectomy has risk for osteoporosis
give unopposed oestrogen
56.Family history+ high plasma Calcium + low Urine
calcium is = Familial hypocalcuric hypercalcemia
Treatment : no treatment
57.Best initial treatment for carcinoid Syndrome is =
somatostatin analogues (octreotide) Then Hepatic
artery embolization
58.Viral infection + tender Goitre + high ESR +
globally reduced uptake on radioactive iodine(,or no
uptake) + initially hyperthyroidism then
hypothyroidism is = Sub acute (De Quervain's )
thyroiditis
59.Treatment of DeQuervain thyroiditis :
Usually self limiting no treatment Thyroid pain= aspirin or
other Nsaids Steriods if hypothyroidism
Beta blockers to control tremor No role of antithyroid drugs
60.Radioactive iodine uptake (RAI 131 scan)In graves = high
homogeneo
us diff
use uptake
Toxic nodular goitre = patchy uptake or solitary area of high uptake
DeQuervain thyroiditis=no uptake or reduced uptake
Rheumatology pearls
1. Poorly controlled Rheumatoid arthritis + Proteinuria+
hypoalbuminemia is=Systematic Amyloidosis, Do rectal biopsy
2. Elderly man +pain and stiffness in shoulder pelvic girdle proximal
not weakness is=polymyalgia rheumatica ,check ESR level
3.Turkey patient + oral ulcers + genetic ulcers + anterior uveitis
+ thrombosis + aseptic meningitis + abdominal pain +
diarrhoea colitis + erythema nodsum is = Behcets syndrome
4. Urethritis + conjunctivitis + Arthritis + history of GI infection +
brown papules on palms and soles + circinate balnatis is = Reactive
Arthritis
5. Bone fractures + bone pain + low calcium + low
phosphate + high Alp + high PTH + losser's zone on x-ray is=
Osteomalacia
6. Foot drop + abdominal pain + livedo reticular
is + r
enal failure + HTN + purpura + testicular pain + Hep B serology +No lung
involvement is= Polyarteritis nodusa
7. Arabs,itians ,Turks Jews azarbijans+fever+abdominal pain +signs
of peritonitis + pluritis+leg joint involvement+ inflammation of
tunica vaginals + increase WBC c Reactive is=Familial mediaterian
fever give colchicine
8. Dull shoulder pain + global restriction of shoulder movement in all
direction +external rotation more effected +pain at rest +movement
effected in active and passive +diagnosis is clinical no investigation is
required is=Adhesive capsulitis
9. Raynaud disease + tight skin in face +below e
lbow and
below knee+ anti centromere antibodies + scerlodactly + oesophageal dysmotity
+calcinosis is=Crest syndrome
10.Antibody showing renal crisis in systematic sclerosis is= anti RNA polymerase
III antibody RHEUMATOLOGY PEARLS
11. +Tightening of skin in upper limb above elbow lower
limb above knee trunk +Hypertension + lung fibrosis + renal
involvement + anti scl 70 is =Diffuse cutaneous systematic
sclerosis
12. Foot drop ,ulnar nerve palsy + purpuric rash +arthralgia + low C4 level
is = Cryoglobulimia
13. Old patient +pain on base of thumb + tenderness
and swelling on 1st carpometacarpal joint + crepitus
+pain on abduction of thumb + atrophy of thenar
muscles is=Osteoarthritis
14. Old man +weakness in finger flexors + weakness of
shoulders + difficulty in swallowing + Ck level normal + muscle
biopsy shows internuclear or cytoplasmic tubofilaments is
=Inclusion body myositis
15. Women patient + anticardiolipin antibody + lupus anticoagulant +high
Aptt (does not improve af
ter human
plasma )+venous ,arterial thrombosis + low platelets is=
Antiphospholipid antibody syndrome
16. Don't give anticoagulation in Behcets even with thrombosis give
steroids
17. Cyclophosphamide causes premature ovarian failure and infertility
18. Raynaud phenomenon + myositis + fibrosing alevolitis + mechanic
hands i.e. thickened ,cracking and peeling skin +Ck level high +proximal
myopathy+anti jo1 antibody is =anti synthase syndrome /polymyositis
19.Spastic paraplegia +upper motor signs in lower limbs +urinary
retention +HTLV1 positive is = Tropical spastic Para paresis
20. Massive hepatosplenomegaly + pancytopenia + bone fractures +
yellow papules (pingueculae )+no brain pathology +
Erlenmeyer
flask shaped cyst is = Gaucher disease
21. Long term management in patient with idiopathic
intracranial Hypertension is =weight loss
22. Pauci articular still disease has ANA
positive but systematic still disease has
negative ANA + RF
23. Pain and swelling over lateral dorsal
aspect of wrist +Finklestein test positive is=De
Quervain's tenosynovitis
24.Hip replacement gram positive
bacillus think of = propionibacterium
acnes
25. Organism associated with
development of RA is =Proteus mirablis
26. Gout +warfarin use give = Rasburicase
27. African Caribbean lady +Well
demarcated macular rash with erythema
,scales, plaques atrophy + photosensivity
+scaring alopecia + negative ANA and anti
dsdna is=Discoid lupus
28. Swollen tender mass in calf + Doppler
u/s shows compressible lumen +
osteoarthtris is = Baker's cyst
29. 30 year old + absent limb pulses + unequal
blood pressure in upper
limbs +
Carotid bruit + claudication + TIA + angina + aortic
regurgitation + glomerulonephritis + high ESR Crp is =
Takayasu's disease
treatment with steroids
30.Best way to differentiate primary Raynaud Disease and
Raynaud secondary to connectivity tissue disease is =Nail fold
capillarsocopy i.e. distorted missed nail fold capillary loops
31. Confirmation test for carpal tunnel syndrome is=EMG /nerve
conduction studies
32 . Smoker + pain on walking + digital ulcerations + cyanosis
and gangrene of fingers and toes + absence of pulses in radial,
dorsal pedis tibial artery +burning sensation in fingers is =
Burger's disease
33.⛹♂Sitting down..... relieve the pain of spinal stenosis.
⛹♂Sitting
down..... aggravate the disc prolapse pain .
both cause low back pain which extended to the LEG.
34. Back pain + leg raise pain aggravated +sitting relives pain or leaning forward
while walking +pain with extension of lumbar spine + loss of lumbar lardosis is=spinal
stenosis
35. 4 to 8 years of age +hip joint hip pain + limp + decrease hip movement +x-ray
widening of joint space + decrease femoral head size is= perthes disease
36. Drug for long term renal involvement in SLE is =Mycophenolate mofetil
37. Stains has interaction with grape fruit juice
38.
cute gout + colchine contraindicated + small joints involvement + renal failure =
give oral steroids not intraarticular that is used for large joint involvement
39. S
LE: norma
l CRP unless an infection
40. The recommended treatment for myelosuppression
secondary to her methotrexate therapy is with folinic acid
rescue therapy
41. Bilateral proximal myopathy + neuropathic pain in thighs
+absence of lumbosacral structural lesson is =Diabetic
amyotrophy
42. Loin pain + haematuria in Antiphospholipid syndrome
-> renal vein thrombus
43. Osteoporosis treatment
1st line oral bisphosphonates
1st aldereonate if contraindicated then risedronate or etidronate
2nd line raloxifene and strontium Donosumb
Raloxifene contraindicated in thromboembolism
Strontium contraindicated in thromboembolism
Teriparatide contraindicated in previous hyperparathyroidism
Donosumb has side effects of diarrhoea ,dyspnoea
,hypocalcaemia and upper respiratory tract infection.
44. Bisphosphonates and Donosumb used
to prevent
pathological fractures in bone metastasis .
if eGFR less than 30 , Donosumb is preferred Donosumb is not used for preventing
skeletal related events with bone Mets from prostate carcinoma
45. Painting/playing tennis +pain and tenderness in lateral
epicondyle + pain worse on wrist extension against resistance with
elbow extended or supination of forearm with elbow extended
+pain on wrist dorsiflexion and middle finger extension is= Lateral
epicondylitis /tennis elbow
46. Painful abduction between 60 to 120 degree + tenderness over
anterior acromion + calcification on x-ray is=supraspinatus
tendonitis/ Sub acromial impingement painful arc
47. Pain through out body with tender points + lethargy + sleep
disturbance , headache + normal blood lab normal ESR is =
Fibromyalgia treatment is explanation, aerobics exercise, CBT
drugs :pregablin ,duloxetine, amitriptyline
48 . Methotrexate used as a steroids sparing agent in difficult to control
, frequently relapsing giant cell art
eritis
49.
Elastic fragile skin + recurrent joint dislocation easy bruising + aortic
regurgitation + MVP + subarachnoid haemorrhage + angiod retinal streaks
+ type 3 Collagen is =Ehler danlos syndrome
50. 10 to 15 years of age + obese child +knee or distal
thigh pain + loss of internal rotation of leg in flexion
+displacement of femoral head epiphysis posterior inferiorly
is =Slipped upper femoral epiphysis
51.SLE + Systematic sclerosis + Polymyositis +Raynaud
phenomenon + puffy hands + arthralgia + myalgia AntiRNP
positive is =Mixed connective tissue disorder
52. Fever more than 5 days + cervical lymphadenopathy +
erythema and oedema of palms and soles with desquamation
of skin + nonpurlent bilateral conjunctivitis + strawberry
tongue + coronary artery aneurysm On Echo =Kawasaki disease
/
Lymphomucocutaneous disease
Treatment give aspirin and IVIG
53. NICE They now recommend diseasemodifying
anti rheumatic drug (DMARD)
monotherapy with a short
-course of b
ridging prednisolone. In the past dual DMARD
therapy was advocated as the initial step.
54.Multiple small joints + gout = oral steroids for
large joint use intraarticular steroids
55.Methotrxate can be used as steroid sparing
agent in giant cell arteritis
56. 3 weeks of osteomyelitis = x-ray foot not
MRI
57.Systmatic sclerosis + lung involvement
restrictive pattern treated by = high dose oral
steroids and cyclophosamide
58.RCP guidance states that individuals should
be given prophylaxis against osteoporosis if they :
Are under 65 years Require steroids for longer than
3 month a have T score of less than -1.5
59.Best way to monitor disease a
ctivity in
Paget disease is = 6 monthly alkaline phosphatase
level
60.In Paget disease skeletal survey >bone scan
INFECTIOUS DISEASE PEARLS
1.. Patient presents with dysuria +urethral discharge + gram staining
shows neutrophils but no bacteria is= Chlamydia trochmatis
2.Azithromycin is treatment of choice for Lymph granuloma venrum.
3.Meningitis + brainstem involvement + immunocompromised patient is = List
eria men
ingitis
4.Ataxia + seizures + headache + menigism + pneumonia + diarrhoea + not
responding to cephalosporin + trumblibg motility is = Listeria monocytogenes
Diagnosed by blood Culture
5.Treatment of Listeria meningitis : IV amoxicillin/ampicillin and gentamicin
(cephalosporin usually inadequate)
6.Lymphocytic CSF predominates in TB and fungal meningitis
7.Urethral discharge + dysuria + gram
negative dipplococci = Gonorrhoea
8.Tenosynovitis+
migratory po
lyarthritis + dermatitis = disseminated gonococcoal infection
9.Patient with Gonorrhoea received ceftriaxone but unfortunately his
symptoms have not resolved is = coexistent infection chlamydia
10. Treatment of Gonorrhoea
Cephalosporin (cefixime or ceftriaxone) Is treatment of choice
Ciprofloxacin was used
11.Investigation for Gonorrhoea Standard Culture fail to grow selective media is
needed like Thayer Martin medium
12.Dysuria + penile discharge thin colourless + had sexual intercourse + urethral
swab 10PMN/HPF no bactermia is = nongonococal urethritis
13.Treatment: doxycycline 7 days or azithromycin Erythromycin is 2nd
line
14..Complications of Gonorrhoea
Local: urethral stricture
Epidymitis
Salpingits (infertility)
DG Imononarthritis + pustular rash synovial fluid is suggestive of joint sepsis in young
woman is gonococcal arthritis
16. HIV patient + Cottage cheese and tomato ketchup or (pizza)
appearance is = CMV Retinitis
Treatment: Ganiclovir (Side effects : myelosuppression do
CBC) Foscarnet If both contraindicated give = Cidovir
17.Dyspanae + CD count less 200 + dry cough + fever +
exercise induced desaturation
Lymphadenopathy + choroid lesion + HSM + very few
chest signs is = pneumocystis jiroveci pneumonia
18.Lab in pneumocystis jiroveci pneumonia
CXR : bilateral interstial pulmonary infiltrates lobar consolidation or
normal
Exercise induced desaturation
BAL silver stain showing cysts
19.Treatment of pneumocystis jiroveci pneumonia :
Co -Trimoxazole
IV Clindamycin(not used as prophylaxis)
IV pentamidine
severe cases Steriods when Hypoxic PO2 less than
9.3kpa or less than 70mmhgDapsone
20.Treatment of l
ung absc
ess = Cefuroxime + metronidazole
21. History of sinusitis + fever+ headache CNS signs + seizure + meningeal irritation + ring enhancing lesion on
CT
scan is = pyogenic brain abscess.
22. DD of Ring enhancing lesions :
Pyogenic brain abscess
Toxoplasmosis
Cerebral metastases
Histoplasmosis
Primary brain tumours giloblastoma multiforme
23. Walking barefoot + abdominal pain + Diarrhoea + pneumonitis + papulovesicular rash on soles
of feet buttocks linear rash over groin(larva current) + eosinophilia = Strongyloides stercoralis
24. Treatment Strongyloides stercoralis :
Ivermectin
Albendazole
Thiabendazole
25.if patient has Strongyloides and HIV diarrhoea then treat 1st Strongyloides then HIV
26.Children + perianal itching at night + sticky plastic tape at perianal area and see eggs is = Enterobius
vermicularis(pinworm
)
Treat
ment : bendazoles i.e. menbendazole
27.Nemtodes which causes anaemia is = ancylostoma
duodenale N nector Americans
Treatment: bendazoles.
28.Rainforest region + transmitted by chrysops deerfly
+ Itchy red swelling below skin Calabar swelling +
urticaria + pruritis + eye work is= Loiasis loa loa
Treatment : diethylcarbamazine
Ivermectin (DOC) Both drugs contraindicated if microfilals exceeds
2500
29.Eating raw pork + fever + perioribital oedema +myositis is
=
trichinella spiralis
Treatment: bendazoles
30.Black files + blindness + hyper pigmented skin + allergic
reaction to microfilaria is = onchocerca volvus
Treatment: ivermectin River blindness
31.Lyphmodema elephantiasis = wanchere bancrofti Tropical
eosinophilia =mylasia fatigue w8 loss cough dyspnoea
lymphadenopathy high level of eosinophilia + bilateral reticulocyt
osis shado
wing
Treatment : Diethylcarbamzine
32 Dog faces eggs + visceral larva migrans + eye granulomas, liver lung involvement is =
toxocara canis
Treatment : diethylcarbamazine
33. Pneumonitis + intestinal obstruction + Loffler's syndrome + biliary pancreatic duct
obstruction = Ascaris
Treatment: piperazine for bowel obstruction
Menbendazole for other infections.
34.Painful liver mass + flushing urticaria + anaphylactic reaction + liver cyst obstructive jaundice +
Ct abdomen best test is = hydatid disease
Treatment: Albendazole and aspiration.
35.Seizures + Ct brain periventricular cystic lesion in partial love Swiss cheese appearance ,=
Neurocysticerosis
Taniae solium (uncooked pork) Taniae saginata (beef)
Treatment : niclosamide
36.Swimmer's itch + haematuria + bladder calcification (Squamous cell
carcinoma) + frequency =
Schistoma
haematobium
Schistoma japonicum causes spinal cord compression
37.Treatment
of schistosomiasis:
S.haematobium and S.mansoni = Praziquantel 40mg for 3days
S.japonicum = Praziquantel 60 mg for 6days+Prednisone 1mg
38. Cholangiocarcinoma = clonirchis sinensis
Treatment: Praziquantel
39.Same as tuberculosis + brown red sputum + fever night sweats rashes
urticaria
+ eosinophilia + symptoms not as severe as tuberculosis is =
Paragonimiasis
Treatment: Praziquantel
40.Cutaneous larva migrans = Ancylostoma brazillience
Visceral larva migrans = toxocara canis
Treatment of Ancylostoma brazillience = Ivermectin
41. High fever + stridor + drooling saliva (specific sign) + rapid onset + cheery red epiglottis is
= Acute epiglottitis
Organism : Haemophilus influenza type B
42.Lab of acute epiglottis
Preferred method : Direct visualization of epiglottis cheery red epiglottis
Lateral neck radiographs=swollen epiglottis (thumb sign)Blood Culture]
43.Cough =croup Drooling of saliva=Acute epiglottitis is Laryngo
malcia i
mprove in prone position
44. Treatment of acute epiglottitis
Unstable=early intubation
Stable,=ICU monitoring 3rd generation cephalosporin ceftriaxone Hib vaccine rifampicin
prophylaxis
45. Widespread pruritis + linear burrows on side of fingers ,interdital webs + flexor aspects of wrist + skin
scrapings
sarcoptes scabei =scabies
46.Treatment of scabies:
1st line : permethrin 5%
2nd line : Malathion 5%
47.Suppressed immunity +HIV patient + crusted skin scabies Is = Crusted(Norwegian) scabies
Treatment : Ivermectin
48.Cattle sheep /unpasteurized milk infected cow in abattoirs +fever chills sweats + confusion
+abdominal pain diarrhoea + hepatosplenomegaly ,+ low platelets + Vasculitis rash is = Q fever
coxiella burneti
49.Q fever Endocarditis:
Aortic valve involvement Murmur not always present.
low grade fe
ver(or no
fever)
Signs of heart failure
Clubbing
Hepatosplenomegaly
Vasculitic rash
50. Lab of Q fever:
Confirmation Q fever antibody coxiella burneti IgG or igA greater than 1:2000
Anaemia
Low PLT
High ESR
High immunoglobulin's
Abnormal LFTS
Haematuria
51.Doxycycline is treatment of choice , Macrolides
52.Decreased consciousness , dysphagia + epilepsy history or Alcohol history +
fever+
features of pneumonia is = Aspiration pneumonia
Treatment: amoxicillin + metronidazole
53. Risk factors of Aspiration pneumonia:
Epilepsy
High alcohol intake
Use of recreational drugs with history of drug overdose.
54.Altered mental status + fever headache + neck stiffness + seizures +
erratic behaviour + Ct or MRI mass in temporal love for lap high
protein, high lymphocytes, normal csf glucose +PCR for HSV is=Herpes
encephalitis
Treatment : HSV encephalitis = IV/acyclovir Acycl
ovir re
sistant =Foscarnet
55.HSV encephalitis is confirmed by =CSF PCR HSV
56. Business man + fever + pharyngitis +
generalized lymphadenopathy + maculopapular
rash + mouth ulcers + low WBCS Lymphocytes low
platelets ,atypical Lymphocytes is = Acute HIV
disease ,(seroconversion illness).
57. Hiv (RNA )PCR and p24antigen confirm diagnosis
of acute HIV disease seroconversion illness
58.Infectious mononucleosis in teenage years and rash
after ampicillin unlike HIV illness.
59.Flow cytometry used measure CD4 count in HIV
patients : CD4 less than 350 = opportunistic infections
3years CD4 less than 200 = 80%risk of developing OI in
CD4 100-200=PCP and Oesophageal candidiasis
CD4 less than 50= disseminated
mycobacterium avium complex and CMV Retinitis
blood Culture next step to confirm to diagnose
60.Start antiretroviral therapy in every HIV positive individual
reg
ardless of
CD4 count
DERMATOLOGY
PEARLS
1.Symetrical + brown + velvet plaques on neck, axilla and groin is
acanthosis nigricans
2.Causes of Acanthosis nigricans:
Adenocarcinoma of stomach
DM
Obesity
PCOS
Acromegaly
Cushing syndrome
Hypothyroidism
Familial Prader Willi syndrome
Drugs: OCP nicotinic acid
3.Shiny painless areas if yellow red skin on shin of DM patient thickened blood vessel is= Nacrobiasis lipodica
Treatment : topical steroids Injectable steroids Camouflage creams
4.Tender erythema nodular lesion on shins is = Erythema nodsum Treatment: usually resolve
with in 6weeksNsaids ,light compression.
5.Causes of Erythema nodsum:
Streptococcus infection most common, Brucellosis , tuberculosis ,
sarcodosis ,
IBD.
Behcets
SLE
malignancy
HLA
Drugs causing Erythema nodsum :
OCP
Sulphonamide
s Penicillin
Antipyretics
Montoleukast
Hepatitis B
vaccination
Omeprazole
Pregnancy
B 27 27
7.Pinkish pearly white papules with central umbilical on occur any where except
palms and soles + children +
HIV less than 200 count is =
Molluscum contagiosum by pox
virus Treatment: usually
resolved watchful waiting
Troublesome : simple trauma cryotherapy topical imiquoid cathardin Itchy :
topical steroids fusidic acid.
8.Skin disease associated with HIV :
Molluscum contagiosum
Corweign scabies
Saborhic dermatitis
9.Sysmmetrical erythematous lesion and raised pinkish indurated lesion
and shiny orange peel skin is = Pretibial myxoedema seen in graves disease
10.Skin disorders with Tuberculosis is :
Lupus Vulgaris
Erythema nodsum
Scarring alopecia
crofuloderma
crofuloderma
Verrucosa cutis
Gumma
11.Erythmatous flat plaque elevated ulcerated with apply jelly colour and
centre scar is = lupus vulagris
Treatment : antiTuberculosis Drugs
12.Papular lesion hyper pigmented depressed centrally associated with
DM,HIV lymphoma is = Granulomas annulare
Treatment: resolved spontaneous Steriods
13.Mainstay treatment of granuloma annulare is =
Observation.
14.Infrated radiation sitting to fire heater + reticulated
erythematous patches hyperpigemented telangiectasia +
hypothyroidism is = Erythema Ab igne If not treated with
develop squamous cell cancer
15.Well circumscribed raised erythematous lesion on finger tender
which bleeds when touched =pyogenic granuloma.
16.Solitary lesion with central areas of ulceration volcano or crater is =
Keratoacanthoma
Treatment : sponatoulsy regress with in 3minSu
ch lesion should be excited
17.Red indurated papules later narcotic black
easchar at centre + middle East with
cattle/sheep/goat is = Cutaneous anthrax
Treatment: resolve on 80-90% Penicillin for treating
infection.
18.IgA deposit within blood vessel = HSP Granular
IgA deposit in Basement membrane is = dermatitis
herpertiformris
Intracellular igA deposit in pemphigus.
19.Streptococal sore throat 2-4 weeks + tear drop scaly
papules on trunk and limbs is = Guttate psoriasis
Treatment: if lesion not widespread (<10%body
surface areas) not impacted physically,
psychologically or socially = no treatment resolved
within 2-3month
if patient desire treatment then topical agents
If lesion widespread >10%body surface area =Refer urgent
dermatologist phototherapy UVB phototherapy = recurrent
episodes referral ENT should be cons
idered
= Tonsillectomy.
20.Erythmatous sharply demarcated papules and rounded plaques covered by
silvery scales +HLA-B13,B17 cw6 + nail pitting oncycholysis koebnar
phenomenon + anterior uveitis = psoriasis
21.Complications of Psoriasis are :
Psoriatic arthropathy
Metabolic syndrome
Increased CVS disease
Venous thromboembolism Psychologically distress
Drugs causing psoriasis
are : Beta blockers
Lithium
Antimalarial (chloroquine,
hydroxychloroquine) Gold
Nsaids
ACEi infliximab BB
>ACEI Withdrawal
systematic steroid
Trauma
Alchols
23.Treatment of Psoriasis :
Topical steroids 1st line : potent steroids once daily + vitamin D
2nd line: vitamin D twice daily
Third line : potent steroids twice daily diathronl Side effects are :steroids skin atrophy striae
rebound symptoms.
Secondary management : UV B light : phototherapy psoralen + UV A light (PUVA) it's Side affects are
: skin ageing Squamous cell carcinoma Systematic :oral methotrexate cyclosporine TNF inhibitor like
Brodalumab = IL-17
Rituximab=CD20
Toculzumab =IL-6
Ustekinumab =IL12 and IL-23 Side effects are : dental ulceration.
24 Never use Oral steroids in Psoriasis.
25.Treatment of pyogenic granuloma Lesion in pregnancy
and post partum resolve sponatoulsy If persist then
removal curettage and catherization cryotherapy excision.
26.Herpes simplex virus is commonest cause of Erythema
multiforme.
27.Target lesion like bulls eye and symmetrical distribution on
dorsal surfaces of extensor extremities is =Erythema multiforme
Treatment: supportive.
28.Causes of Erythema multiforme are :
Virus herpes simplex virus
Mycoplasma streptococcus
Drugs: Penicillin, sulphonylurea, barbiturates, carbamazepine,
Allopurinol, NSAIDS,OCP nevirapine
SLE
IBD
Sarcodosis
Malignancy.
29.Severe macular atypical target lesion mucosal involvement on
face and trunk + less than 10% body involvement+ fever
arthralgia is =Steven Johnson syndrome Causes are same as EM.
30.Pyrexia + tachycardia + niklosky sign positive + severe
mucocutaneous exfolitive disease is =Toxic epidermal
nacrolysis
Treatment : stop precipating
Iv immunoglobins
Immunosuppressive cyclosporine
cyclophosphamide plasmaphresis
31.Causes of Toxic epidermal nacrolysis are :
Viral
Leukaemia
Lymphoma
Drugs.
32.Drugs causing Toxic epidermal nacrolysis are :
Phenytoin
Sulphonamides
Allopurinol
Penicillin
Carbamazepine
Nsaids
33.50-60 years + Diabetic + swollen red warm foot
and ankle + high arched foot + neuropathic + Normal
C reactive white cells unlike osteomyelitis is =
Charcot foot
Diagnosed by :X-ray Indium labelled white cell scan
best way to differentiate Infective causes.
34.Treatment of Charcot foot Immobilisation in case for
3-6 month Total contact plaster Bisphosphonates
Surgery
Good blood glucose control.
35.Female 40-60 years +diabetes/DVT + ulcer on
medial/lateral malleous which pink yellow green hair thick
hardened +ABPI 0.9+ venous ulcer Treatment: multilayer
banding For banding u need ABI of 0.8
36.Male >60years +HTN/DM/ hyperlipidaemia/smoking + severe pain on heel
metatarsal regular deep green absent swelling +ABI <0.75 no hair rubor thin shiny
skin is = Arterial ulcer
37.Causes of scarring alopecia (destruction of hair follicle) are :
Trauma
burns
Radiotherapy
Lichen planus
Discoid lupus
Tinae capitis.
38.Causes of non scarring alopecia (preservation of hair follicle are :
Male pattern baldness
Drugs: cytotoxic drugs , carbimazole,heparin ,OCP colchine Iron zinc
defienancy
Alopecia areta
Tolgen effluvium
Trichotillomania
39.Localized patches of nonscarring hair loss + exclamation marks tapered towards
base is = alopecia areta
Treatment: hair will regrow in 50%Topical or intralesional steroids
most appropriate Others topical minoxdil, photo therapy diathronl
immunotherapy wig
40.After puberty diffuse slow hair loss with characteristic loss over temporal regions
and vertex in male is = Androgenetic alopecia
41.1 to 3 month after viral illness, surgery, childbirth ,
emotional stress diffuse hair loss + hair loss never
complete usually stops after 3 to 5 month is = Tolgen
effluvium
Treatment : hair regrowth.
42.Children + localized hair loss but in bizarre pattern +
patient pull their own hair + hairs of different length is
=Trichotillomania
43.Scarring alopecia + atrophic with visible loss of hair follicle
is=Discoid lupus erythramatous
44.Permanent bald patches with no visible follicles
is = Cicatrical alopecia Treatment: treatment of
underlying cause like (DLE,lichen palnus ) topical
Steriods.
45.Elderly patient sun exposure + at head and neck
pearly flesh colured papule with telangiectasia ulcerated
leaving central crater is = basal cell carcinoma
46.Treatment
of basal cell carcinoma :
surgical removal
Curettage
Cryotherapy
Topical cream : imiquoid fluorouracil Radiotherapy
47.Old patient retired may be builder working in sun exposed
areas + small crusty scaly lesion + pink ,red , brown on temples of
head is = Actinic keratosis/solar keratosis Treatment: prevention :
sun avoidance sun cream
Fluorouracil Topical diclofenac, Topical imiquoid
Cryotherapy Curettage and cautery
48.Elderly male + scalp forehead pruritic patch or plaques often
nodules that may bleed is = Angiosarcoma
49.Elderly + stuck on papule or nodule + barnacles of
aging + variation in colour from flesh to light brown to black
on chest, back head neck is = Saeborrhic keratosis/basal cell
papilloma
Treatment : Reassurance Curettage and cautery
croyrotherpy for thinner lesions
50 Nacrobiasis lipodica and non atrophic skin = Topical steroids
51.Hyperpigemented scaly lichenified + History of chronic
scratching or manipulation site is ankle is = Lichen simplex
chronics.
52.Uses of narrow band phototherapy are :
Psoriasis
Mycosis fungoides patch stage
Vitiligo
Eczema
53 Lower limb small red papule deep, red narcotic ulcers violaceous
border serpiginous outline undermined bluish is = pyoderma gangreosum.
54.Causes of pyoderma gangreosum are :
IBD UC> Crohn's
RA,SLE
Myeloperlifertive disorders Lymphoma leukaemia
Monoclonal gammopathy
PBC.
Treatment of Pyoderma gangreosum is :
1st line : Oral steroids
1st confirm pain relief Culture biopsy then oral Prednisolone
2nd line ciclosporin,infliximab.
56 .10-35 years +Herald patch on trunk + erythematous oval scaly patches
fir tree appearance is = Pityriasis rosea caused by Herpes hominis virus 7
Treatment: usually disappears after 4-12 weeks.
57.Patches hypo pigmented pink brown scale on truck in
immunocomprismed /malnutrition is = Pityriasis versicolor (Tinae versicolor)
caused by Melassezia furfur
Treatment: topical antifungal ketoconazole topical selenium sulphide
Extensive=Oral itraconazole.
58.Tender erythematous indurated plaque with sharply demarcated border is =
Erysipelas caused by streptococcus pyogens (group A)
Treatment: Benzylpenicilin if allergic then erythromycin
Complications are :sepsis, cerebral abscess ,venous sinus thrombosis
59.Treatment of Eczema :
Topical steroids :Mild : hydrocortisone
Moderate : Clobetasone butyrate 0.05%,betamethasone valerate
0.025% (Betnovate BD) Potent: betamethasone valerate
0.1%(Betnovate), Fluticasone propionate
Very potent : Clobetasone propionate 0.05%.
60.Inflamed itch crackle rough blisters on neck and face of children +fever = Eczema
Herpticum
Treatment: acyclovir
PHARMACOLOGY &
TOXICOLOGY
1. Overdose of benzodiazepines + reduced conscious
level +respiratory depression =intubate and ventilate
rather than flumazenil
2.Clozapine not only cause agranulocytosis but
also myocarditis so never forget to do ECG prior to
it's use
3.. Some clues about poisons :
ecstasy all hyper except sodium.
Methotrexate : cerebellar signs
Cocaine : chest pain , ECG wide QRS .
Ghb : patient usually in coma and may show some lucid
interval Nexus: nasal pain, tactile sensation increased
4. Drugs causing peripheral neuropathy
:VITNAM
Vincristine
INH
TCA
Nitrofurantoin
Amiodarone
Metronidazole
5.Drugs causing retroperitoneal fibrosis are:
Bromocriptine
Beta blockers
Methlyseriglycide
6.Drugs causing lymphocytic colitis are :
PPI
NSAIDS
SERTALINE
7.Osteonecrosis of jaw is well recognised
complication of bisphosphonates therapy
8.Nsaids:COX-2 selective inhibitor (Celecoxib,rofecoxib)
associated with increased risk of thrombotic risk (MI and
stroke) but associated with lower risk of upper GI side
effects good in ulceration or bleeding
Non selective Nsaid=also associated with Elevated risk of
thrombotic risk(,diclofenac and ibuprofen) Naproxen has
lower risk of thrombosis hence best choice
9.Drugs causing acute dystonia :
Neuroleptics (Haloperidol,levomepromazine)
Antiemetic's(metoclopramide)
Antidepressants (amitriptyline,trazodone)
Management :stop drug fallowed by eith
er benztropine or diphenhydaramine ,
benzodiazepines may be helpful.
10.Drug causing Hypertension are :
Steroids
monoamine oxidase inhibitors
the combined oral contraceptive pill
NSAIDs
leflunomide
11.Contraindications of beta blockers :
Heart block
uncontrolled heart failure
Asthma
sick sinus syndrome
concurrent verapamil use: may precipitate
severe bradycardia
12.Indication of statin :
Primary prevention:10 years CV risk is 10%or
more OR most type 1diabetes Or CKD if GFR less
than 60 give =Atorvastatin 20mg (if non HDL is not
fallen by 40% then titrate up to 80mg Atorvastatin
Secondary prevention : known ischemic disease of
stroke or peripheral atrial disease give = Atorvastatin
80mg
13.Treatment of carbon monoxide :
Apply tight fitting non rebreather mask and give
100%oxygen If patient is comatose then intubation
and ventilation with 100% oxygen
71 14.Side effects of statins :
72 myopathy
73 myalgia, myositis,
74 Rhabdomylosis
75 asymptomatic raised creatinine kinase
Myopathy is more common in
(simvastatin, atorvastatin) than
(rosuvastatin, pravastatin, fluvastatin).
76 liver impairment: the 2014 NICE
guidelines recommend checking LFTs at
baseline, 3 months and 12 months.
77 Treatment should be discontinued if serum
transaminase concentrations rise to and persist
at 3 times the upper limit of the reference range
statins may increase the risk of intracerebral
haemorrhage in patients who've previously had
a stroke avoid in patient with intracerebral
haemorrhage
78 15.Cyclophosphamide Adverse effects :
79 haemorrhagic cystitis : incidence reduced by the
use of hydration and mesna
80 Myelosuppression
81 transitional cell carcinoma
82 16.Treatment of cyclophosphamide induced
side effects =Mesna2-mercaptoethane
sulfonate and metabolite of cyclophosphamide
called acrolein is toxic to urothelium mesna
binds to and inactivates acrolein helping to
prevent haemorrhagic cystitis
83 P
HARMACOLOGY&
T
OXICOL
17.Phases of drugs Phase I =studies study safety =
phramcokinetics,phramcodymanics first usage in human subjects.
Phase II=studies are designed to elucidate any therapeutic response in
specific settings combined with phase I .
Phase III = Performed once initial safety and efficacy evaluation is completed ,
compare the drug with alternative.
18.Side effects of Ketamine are :
Raised intracranial pressure i.e. headache,
papilloedema,vomiting Hypertension
Hallucinations
Bladder and liver dysfunction
Side effects of Exogenous
androgens are : Acne
Gynaeco
mastia
Hyperten
sion
Hypercho
lesterole
mia
Hepatic
tumours
Paranoid
delusions
2
0
.
O
p
i
a
t
e
s
s
a
f
e
i
n
r
e
n
a
l
impairment are : Fentanyl
84 Bu
pr
en
or
ph
in
e
M
et
ha
do
ne
21.Drugs altering absorption or clearance of Thyroid :
Cholestrayamine
Ferrous sulphate
Lovastatin
Aluminium hydroxide
Rifampicin
Amiodarone
Carbamazepine
Phenytoin
22.Drugs causing thrombocytopenia
Quinine
Diuretics
Sulphonamides
Aspirin
Thiazides
Pseudo thrombocytopenia occurs with use of EDTA Thrombocypenia occurs on 7day of
transplant unlike graft VS host diseases which occur after 2 weeks
23 Carboxyheamoglobin cohb is best for prognosis in carbon monoxide poisoning
dep
when Cr>130 Stop when >150 or GFR less than 30 Recent MI within 6 we
24.Contraindictions to metformin : 85
89
Renal failure 93
hepatic failure 97
heart failure lactic
101
acidosis
CKD review
Alcohol
use,IV contrast
106
angiography.
25. side affects of sulphonylurea are : 110
Hypoglycaemia 113
Weight gain 116
SIADH 119
Liver damage 28.S 122
Photosensitive 125
128 129
29.SGLT-2 batter in HTN and cardiovascular
disease in diabetes mellitus
30. Drugs causing photoxiocity are :
Antibiotics:tetracyclines,fluroquinolones,sulphonamides
Nsaids
Diuretics :furosemide,bumetanide Sulphonylurea
Neuroleptics : chlorpromazine Antifungals:terbinafine
,itraconazole
Other drugs : Amiodarone diltizem
31.In cases of severe theophylline toxicity ,charcoal
haemoperfusion can be used.
32.Acidosis + hypokelmia + vomiting +
tachycardia arrhythmias + seizures is =
Theophylline toxicity
Treatment : gastric lavage if <1 he prior to ingestion
Activated charcoal
Whole bowel irrigation if Theophylline is sustained release
forum
Charcoal haemoperfusion is preferable to haemodialysis
33.Dry cough + dilated pupil + agitation+ sinus tachycardia + blurred vision +
arrthymais, + seizures + 3 Cs convuslion,coma , Cardio toxicity + on ECG sinus
tachycardia widening QRS,prolonged QT is = TCA poisoning
(amitriptyline,Dosulepisn)
QRS >100=seizures
QRS >160= Ventricular arrhythmias
34.Treatment of TCA poisoning :
Mainstay :I/V bicarbonate reduce acidosis Don't use
Quindine,flecainde Amiodarone
Gastric lavage =1 hour of ingestion Charcoal 2hr ingestion if GCS is not reduced IV
lipid emulsion Dialysis is not effective in TCA.
35.Most appropriate intervention in lead poisoning is DMSA
36.Mixed sensorimotor polyneuropathy + pesticides in farmer + nausea, vomiting
gastroenteritis
garlic breath coma seizures+ mees lines + abdominal pain + peripheral
neuropathy is = Arsenic poisoning
Treatment : DMSA (sucimer) penicillamine.
37.Agitiation + confusion + sleepiness lasting up to 24 hours or more + pupils dilated and
unreactive to light + visual and auditory hallucinations is = Procylidine poisoning used to
treat
parkinsonian side effects of neuroleptics.
38.Hypokelmic
alkalosis + high urine potassium + athletes is = Diuretics abuse.
39.Farmer + pesticides + DUMBLESS : Diarrhoea,urination,miosis, bradycardia/
bronchospasm,lacrimation,emesis,salivation,sweating , hypotension, twitching
fasciculation's,
muscle weakness tremor hyperreflexia is = Oragnophosphorous
poisoning (Malathion, parathion)
Treatment:Atropine,pralidoxime
40.Alcohol abuser + nausea vomiting headache confusion early + high anion gap
Metabolic acidosis + retinal injury visual problems with blindness optic neuropathy
macular edema is = Methanol toxicity.
41.Treatment
of methanol poisoning :
1st line : Femipizole inhibit alcohol dehydrogenase
2nd line : if Femipizole not available ethanol (it competes with alcohol
dehydrogenase
Na bicarbonate if PH <7.2
Folic acid to reduce eye symptoms
Haemodialysis
42.Indications of haemodialysis in methanol toxicity:
Worsening acidosis despite Na bicarbonate
Visual problems
Consumer exceeds 30ml Methanol level >20.
43.Antifreeze used for suicide + stage 1 confusion
,slurred speech ,dizziness 2nd stage metabolic acidosis
with high anion gap, tachycardia Hypertension stage 3
renal failure, respiratory, cardiac failure , oxalate stone
symptoms like alcohol is = Ethylene poisoning
Treatment: 1st: Femipizole
2nd line : ethanol
In severe acidosis : Give fluids with bicarbonate
Haemodialysis refractory cases.
44.Oxalte stones = Ethylene poisoning
Eye problems = Methanol poisoning
45.Protamine sulphate is antidote for heparin.
46.Warfarin has narrow therapeutic index affected by drugs like SSRI Sertraline and citalopram are safest
antidepressants with warfarin.
47.Inhibitor of 450 = decease serum level and causes toxicity SICKFACES.COMS:
sodium valproate / SSRII:
Isoniazid
Ciprofl
oxacili
ne
Ketoco
nazole
Fluconazole
A:alchol(acute)/ami
odarone
Cimeti
dine
E:Eryt
hromy
cine
sulphonamides
chloramphenicol
Omeprazole
Metronidazole
Others: Grape juice ,navir, Disulfiram,
quinpristin.
48.Inducer of p450
CRAP GPSC: Carbamazepine
197 p
h
e
Phenobarbitone
S:St John's wart
Smokers
49. 3-7 days after cessation of alcohol
ingestion + visual hallucinations +
autonomic instability (tachycardia,
Hypertension and fever) + obtundation
confusion + sweating , tremor's agitation is
= Delirium tremens
Treatment: benzodiazepines
50.Diaphoresis,shaking,
cramping,agiation , Diarrhoea
but no autonomic instability and
hallucinations is = Opiate
withdrawal.
51.Elevation transaminases more than 100 times
upper
limit of normal is seen in :
ischemic Hepatitis
paracetamol overdose.
52.Co-adminstration of aminophylline and
ciprofloxacin can cause toxicity and macrolides
hence avoided
53.Dance (club ) active guy + agitation anxiety confusion ataxia +
tachycardia + Hypertension + hyponatremia + hyperventilation +
hyperthermia + Rhabdomylosis
blurred vision + acute renal failure+ DIC + ARDs + hyperkalaemia is =
Ecstasy (MDM 3,4 methlynediomethamphetamine ) poisoning
Associated with Serotonin syndrome.
54.Treatment of Ecstasy poisoning :
I/V fluid if temperature >39 Dantrolene if simple measure fail Paralysis
ventilation.
55.Poor prognostic factors in Ecstasy poisoning :
Fever >42
Rhabdomylosis
Renal failure,
liver failure
HTN
DIC
56.Drugs treatment for acute dystonia dyskinesia reactions :
I/V benztropine
Procylidine
Antihistamine diphenhydaramine.
57.Lathergy ,anorexia + nausea vomiting diarrhoea confusion + yellow green
vision + arrthymais AV block is = Digoxin toxicity
58.Precipating factors for digoxin toxicity :
Low k
Low mg
Low PH
Low temperature.
Low albumin
Hypothyroidism
Increasing age
Renal failure
High sodium
Myocardial ischemia.
59.Drugs causing digoxin toxicity:
Quinidine
Verapamil and diltizem but not amlodipine
Spironolactone
Thiazides
Furosemide
Amiodarone
Cyclosporine
Cholestrayamine
colpestol decrease level
60.Treatment of digoxin toxicity
KLAM
Slowly normalize K
Lidocaine ,phenytoin
Digoxin antibody Mg(avoid in bradycardia)
PSYCHITARY
pearls
1..Flight of ideas + pressure speech +
grandiose delusions + elevated mood
is = Mania
Treatment is lithium, sodium valproate
,carbamazepine
2.Mania and hypomania is differentiate by
presence of delusion of grandeur and
auditory hallucination in mania not
hypomania
3.Major disaster, childhood sexual abuse +
re-experiencing flashbacks, nightmares,
repetitive distressing images, avoiding
people or circumstances resembling event
is =post traumatic stress disorder
4.Winter season + hyperphagia + hyper insomnia + weight
gain is =seasonal affective disorder
Treatment expose patient to light for few hours of day
5 .Insomnia + tremor + loss of appetite + perspiration +
tinnitus+ seizures anxiety is= benzodiazepine withdrawal
syndrome
6.Depression +high mood is =cyclothymia
7.Chronic depression +sleep badly, and feel inadequate is=dysthymia
8.Techycardia+HTN + pyrexia + visual hallucinations + agitation is = delirium
tremens
9 .Treatment of alcohol withdrawal is = benzodiazepines Lorazapam
For abstinence = Disulfiram
To reduces craving= Acamprosate
To reduces pleasure that alcohol brings and craving= Naltrexone
10.. 12 to 24 Hours after alcohol withdrawal + visual auditory, tactile hallucinations is =
Alcoholic hallucinosis
11.. Impairment in consciousness + nocturnal worsening + intact memory for recent + visual
hallucinations
is = delirium
12.Fixed ,false, firmly held belief out of keeping with persons social and cultural background
is= delusion Belief of exaggerated importance and often occur in mania = grandiose
delusions
13.Misperception
of stimuli is =illusion
14.Fear of open spaces , crowds + patient can go outside for years is = Agoraphobia
15 .Specific phobia or fear of heights is = acrophobia
16.Lab in Anorexia Nervosa Most things Low except:
3Gs and 3Cs which are high Growth hormone Glucose
Salivary Glands Cortisol Cholesterol Carotinemia High
amylase
17.Features of anorexia Nervosa :
BMI <17.5 Amenorrhea
Hyponatremia
Hypokelmia
Hypocalcaemia
Low FSH LH oestrogens but normal
testosterone Ferritin low
Normocytic anaemia Lanugo hairs
18.Underweight + hypokalaemia + normal BP + calluses on knuckles
+ low urinary potassium is = Laxative abuse from bulimia
1-6 Mon duration + delusions + hallucinations +
disorganized thought and speech + negative symptoms =
Schizophreniform disorder.
2
0
.
P
a
r
a
n
o
i
d
s
c
h
i
z
o
p
h
r
e
n
ia prominent hallucinations and delusional ideations with
preservation of affect and cognitive functions
21.Delirium believe that some one poison him or
nurse is trying to get him out of ward 1st treated
but 1:1 nursing in safe environment Haloperidol
and Lorazapam is used for delirium
.Olanzapine and resperidone causes
Cerebrovascular disease hence avoided
in elderly.
22.Nacrolepsy treated by = Methylphenidate
23.Cateplexy = Clomipramine and fluoxetine
24.Manic episode + risk to herself give = IM
Lorazapam sedation If not available then
Haloperidol.
25.He said he is Jesus because God spoke to him through TV is = Acute psychosis which
may be related to underlying primary schizophrenia
26.Treatment
of acute psychosis is : resperidone
27.False beliefs that she some one trying to harm her she is afraid that they see
her and will hurt her she has proves of it like they keep garbage outside to trap her
Other example is feelings insects crawling over skin = delusions (false believe)
28.She laughs and giggles for apparent reason and she is unable to dress or
shower herself ,rocking muttering softly herself = Schizophrenia in disorganized
type.
29.Unable to eat or drink anything unresponsive both vocally and
nonverbally she resist any attempt to be moved socially isolated bizarre
and speak people no one else could see = Cationic schizophrenia.
30.He has not slept ,bathed ,eaten lack of personal care, in talks to himself
hallucinations is and he says some one stealing his thoughts he fallow making him
unable do school material he is crying feeling of suicide is = Schizoaffective
disorder
31.Hallucinatory voices commanding
him to do things hum or laugh +
delusions like girl friend wants to leave
him and he has illness and won't live
more than 1 year+ hallucinations of
smell i.e. he smell of fish + neglect
personal hygiene = Paranoid
schizophrenia.
32.Side effects of Exogenous androgen
is paranoid delusions and aggressive
behaviour.
33.Sertraline and citalopram appear be
safest with antidepressants with
Warfarin.
34.Alzheimer's + psychic features like
slapping his wife and inhibitor = give
antipsychotics like olanzapine
35. Abnormal clock drawing test in dementia
differentiate it from delirium.
36.Ropinirole D2/D3 dopamine agonist is
associated with changes in behaviour like
gambling high risk sexual intercourse
37.Drugs causing Euphoria:
MDMA
Amphetamines
Cocaine
Mephrodone
38.Delirium is treated by Haloperidol , Lorazapam
Nursing
safe environment
39.Alochol withdrawal = benzodiazepines
40.Disulfiram promotes abstinence but
contraindicated in ischemic heart disease and
psychosis
41.Acromprostate reduces craving weak antagonist of
NMDP
42.Aggressive behaviour + sweating + Hypertension + tachycardia is = delirium tremens
43.Treatment
: benzodiazepines diazepam.
44.1st
line in obsessive compulsive disorder is CBT if resistant then
SSRI
45.Preserved awareness + visual attention tracking patients appear that they are
about to speak but don't = akinetic mutasim
46.He believed that flickering lights were transmitting messages to him as new
Messiah .believed that red car had passed him that morning an epic battle
with devil is pending is = psychotic delusions of reference typical feature of
Schizophreniform
47.Treatment 1st line resperidone
48.Drinks alcohol daily + sweaty agitated + tells u that nurses are trying to poison her but
she trusts u is = Alcohol withdrawal syndrome
49 treatment : give Chlordiazepoxide not resperidone
50.Impulsive behaviour + repeated self
harming over reaction to minor events
accompanied by feelings of emptiness
=Borderline personality
51.Alchol withdrawal = Lorazapam
52.Sczhioperhnia (delusions, hallucinations,
disorganized speech or behaviour negative
symptoms of at least 6 min with at least 1
month of active symptoms ) + major
depressive episode or manic episode like u
believe that there is devil who wants to kill
her hence she wants to kill herself is=
Schizoaffective
disorder
53.Antipyschotic causes skin rash
pigmentation
is chlorpromazine
54.Side effects of Atypical
antipsychotics
is = Hyperglycaemia
Haloperidol = hypoglycaemia
Phenelzine = dry mouth constipation
55.Psychiatric (anxiety, mood liability
,vivid dreams) + GI nausea vomiting +
dizziness headache paraesthesia
dystonia tremor is = SSRI
discontinuation
syndrome.
56.Hallucinatory voices commanding him
to do things or non-verbal forms such as
humming or laughing + delusions which
may be jealousy theme or bodily change
+ hallucinations of smell is= paranoid
schizophrenia
57.Quetapine used for dopaminergic
induced psychosis and hallucinations
58.Low mood + worry sadness anxiety poor concentration
insomnia following recent stressful occurrence + loss of pet
is = adjustment disorder
59. treatment of Adjustment disorder is :
psychotherapy
SSRI
59.No low mood in generalized anxiety disorder.
60.Schzhioaffective disorder has features of both mood
disorder and schizophrenia including psychomotor
retardation features of depression hallucinations and
delusion
ONCOLOGY PEARLS
1. Testicular lump + mass on chest X-ray + raised beta HCG = Testicular
seminoma.
Treatment is = Chemotherapy + Orchiectomy
2.Dyspanae + swelling of face,neck ,forarm,headache + JVP raised + visual disturbance +
fixed dilated neck veins is = Superior vena cava obstruction
3.Investigation of choice For Superior vena cava obstruction is = Ct guided biopsy of
mediastinal mass
4.Treatment of superior vena cava obstruction :
General: Dexamethasone treating underlying cause
In some cases of no small cell carcinoma stenting is required before chemotherapy
and radiotherapy
5.Investigation in breast cancer:
Screening : Mammograms sensitive in older not in younger
BRCA-1 orBRCA-2 mutation screening
Breast MRI
Tumour markers:CA15-3
6.30-40 years + painless + small non palpable mass or
hard testis + symptoms of metastasis + gynaecomastia +
markedly raise Beta HCG and AFP + on ultrasound
heamorrgaes,necrosis,cystic calcified = Choriocarcinoma
7.Chemotherapy used in testicular cancer
B= bleomycin
E= etoposide
P= cisplatin (platinum)
8.Papillary thyroid cancer is treated by
=Thyroidectomy followed by Radioiodine -131
therapy
9.High Alpha fetoprotein + high beta HCG =
Nonseminoma
10.High beta HCG not AFP is = Seminoma
11.Radical orchiectomy is required for definitive histological
staging and treatment fallowed by additional staging studies
such as Ct scan of abdomen and pelvis and radiographs of chest
in testicular cancer.
12.Horseness+odynophagia + ulcerated lesion projecting from
vocal card friable with bleeding = Squamous cell laryngeal
carcinoma Treatment: stage II external beam radiation
13.Hesitancy,urinary retention +
heamaturia,haematospermia + back pain / perineal ,
testicular pain + peripheral zone + asymmetrical hard
nodular
enlargement with loss of median sulcus is =
Prostatic cancer
14.Treatment of prostate cancer:
Localized T1/T2 palpable disease confined to prostate
= Conservative, radical prostectomy , radiotherapy:
external beam and brachytherapy
Localized advanced T3/T4 beyond capsule,
bladder neck or rectum = Hormonal therapy
,radical prostectomy, radiotherapy external beam
and brachytherapy
Metastatic = hormonal synthetic GnRH agonist :
Goserlin luprolide
Anti androgen = Crproteron acetate Orchidectomy
15.Trial of sildenafil is appropriate unless contraindicated for
erectile dysfunction regardless of underlying aetiology
16.Back pain worse on lying down or coughing + lower limb weakness + sensory
loss and numbness + lesion above L1 UMN signs in legs and sensory level lesion
below L1 LMN signs in legs and perianal lesion = spinal cord compression
17.Investigation of choice for Spinal cord compression is = MRI whole spine
18.Treatment for spinal cord compression is
= High dose dexamethasone
Radiotherapy surgery
CNS features=surgery
19.Risk factors for breast cancer:
BRCA-1 or BRCA-2
Early menarche
Late menopause
Nullparity
OCP
Treatment of colon cancer Stage 1 and stage II good risk =
Observation Stage III LN involvement = Surgery + chemotherapy
No role radiotherapy in colon cancer unlike rectal cancer
21.Treatment of small cell lung carcinoma :
Chemotherapy
Prophylactic cranial radiation (brain is frequent site of first relapse after
complete therapeutic response)
No role of surgery
22.Surgery in breast cancer
Indications of mastectomy:
i) Multifocal tumour
ii) central tumour
iii)large lesion in small breast
iv) DCIS more than 4 cm Indications of wide local excision:
i) solitary lesion
ii) peripheral lesion
iii)small lesion in large breast
iv) DCIS less than 4cm Radiotherapy adjuvant given after surgery to prevent
recurrence
23.Lower back/ flank pain + fever + lower limb oedema + haematuria + Bromocriptine
is= retroperitoneal fibrosis
24.Treatment of Colorectal cancer:
Stage I (Duke A) mucosal or sub mucosa treatment : Surgery
Stage II(Duke B) extends into muscularis ,into or through serosa
treatment : Surgery fallowed by radiotherapy
Stage III(Dukes C) extends to regional lymph nodes treatment : Surgery +
Chemotherapy with 5FU and leucovorin and in some patients radiotherapy (large
tumour or invading tissues)
Stage IV (Dukes D) metastasized to distant sites treatment : surgery ,
palltive chemotherapy and or radiotherapy chemotherapy:Cetuximab or
becavizumab
25.Debulking surgery fallowed by chemotherapy is best treatment option for patients
with peritoneal carcinomatosis from ovarian cancer
26. Nice guidelines on Metastatic malignant diseases of unknown primary
origin recommends that if simple initial investigation fail to indicate a site for
further investigation of malignancy of unknown origin then a CT chest,
abdomen and pelvis should be performed
27.Dermtomyocitis is associated with which cancers = breast,lung,git and pancreatic
cancer
28.Management of breast cancer:
Drug therapy Hormonal therapy : Premenopausal
=Tomoxifen
blocking oestrogen receptors Side
effects : vaginal bleeding,
endometrial cancer,
thromboembolism
Postmenopausal : aromatase inhibitor :
preventing conversion
of oestrogen : Anastrole(1st
line),exemestane,letrozole,fulvestrant
Side effects :osteoporosis ,fragility
fracture do Dexa scan Bone disease =
bisphosphonates zoledronic acid 1st
lineHer2/neu (c- erb B2) positive
=Trastuzumab SE Cardiomyopathy so
do ECHO
29.Typhiltis or Neutropenic colitis is serious
complication of Neutropenia
30.Cetuximab k-ras wild type is used in metastatic
colorectal
cancer Side effects : acne type rash
31 HNPCC is associated with increased risk of ovarian
cancer
32. Ovarian cancer treated by = 1st line carboplatin and
paclitaxel combination 2nd line liposomal doxorubicin
(caelyx)
33.AFP + beta HCG + PLAP(placental like
isoenzyme of alkaline phosphatase) used for testicular
teratoma
34.Tumour antigens :
PSA = prostatic cancer
AFP=Hepatocellular carcinoma, teratoma,
Nonseminoma
CEA=colorectal cancer
S-100 = melanoma,schwanomas
Bombesin = small cell lung carcinoma,
gastric carcinoma, neuroblastoma Beta
HCG = choricocarinoma,germ cell
tumours lung cancer
35.Tumor markers :
CA-125 = ovarian cancer
CA19-9= pancreatic cancer
CA 15-3=breast cancer
CEA=colorectal cancer
36.Primary tumours most frequently associated with
metastatic spread to brain are :
Lung cancer
Breast cancer
Malignant melanoma melanoma causes
multiple metastasis where as breast causes
solitary brain lesion steroids and palliation
initial treatment
37.Cancer pain management WHO analgesic ladder as follows:
Step 1-Non-opiod +/-adjuvants (paracetamol/ Nsaids)
Step-2 weak opioid (codeine)+non opioid +/-
adjuvants (co-codamol30/500)
Step3- strong opioid + non opioid +-/adjuvant (morphine,
fentanyl, oxycodone)
38.Cancer drug causing itching is =Morphine
39. For bone metastasis following can be done:
nsaid
Iv bisphosphonates
Surgery
Radiotherapy
40.Levomepromazine is called as Dirty drug because it blocks all
receptors ACh,DA,5HT broad spectrum antiemetic used as 1st line in
last days of life
41. Constipated induced vomiting is treated by
metoclopramide ,domperidone
42.Chemotherapy induced vomiting and nausea treated
by=cyclize, haloperidol
43.Harmonal management of breast
cancer: Tomoxifen =partial agonist and
antagonist of oestrogen .it is 1st line in
premenopausal women DVT is major
Side effects : Anstrazole,exemestane are
aromatase inhibitor = used in post
menopausal women
Fulvestrant = selective oestrogen receptor
down regulator only agent used IV
44.Morphine is contraindicated in renal failure
45. fentanyl can be given in renal impairment.
46.Opiod used in renal failure is Fentanyl
(selective u receptor agonist)
47.Morphine causes renal impairment.
48.1st line antiemetic in
opioid induced nausea
is=Haloperidol
49.1st line for breathlessness in
palltive care is = opioid (morphine)
50.Side effects of opioids :
Constipation
Meiosis
Nausea, vomiting
Urinary retention
Hallucinations
Myoclonus
Delirium
51. Drug used for constipation in palliative care=polyethylene
glycol (Movicol)
52.Lyphmodema in cancer patient is treated by =Skin
care and compression bandaging
53.Treatment of agitation and confusion in
terminal phase:1st line Assess for urinary
retention and consider catheterization if that's
trigger Drug : midazolam
54. 1st line drug in treatment of agitation and
confusion without terminal stage is =Haloperidol
55. Treatment of liver capsule pain
secondary to liver metastases is
dexamethasone ( April 2019 part -2)
56.Antiemetic in palliative care :
Cyclizine = it target dopamine and cholinergic receptor's used in
nausea associated with cerebral diseases (brain Mets) (march
2019 part-2)
Metoclopramide = prokinetic targets dopamine and serotonin used in
delayed gastric emptying a
post chemotherapy, Haloperidol= hits dopamine reception used in toxic
(opioid) or metabolic induced nausea
Levomepromazine = hits all receptors used in terminal stage
57.Cancer causing hypercalcemia are :
Lung cancer
Breast cancer
Renal cell cancer
Multiple myeloma
58. Electrolyte disturbance in refeeding syndrome :
Low P
Low mg
Low K
59. Indication of blood transfusion in palliative care is = disabling
shortness of breath on maximal excretion
OPHTHALMOLOGY pearls
1. MS/DM/ syphilis + Unilateral decrease in visual acuity + poor decrimnation of
colours + pain worse on eye movement + relative afferent pupillary defect + central
sctoma is= optic neuritis
Treatment is with steroids
2.Resfum disease /alport syndrome/Kearns Sayre syndrome + Night blindness +
tunnel vision + black bone spicule shaped pigmentation is =Retinitis pigmentosa
3. MS/ sarcodosis /DM + Small pupil + accommodation reflex present but pupillary reflex
absent is Argyll Robertson pupil
4.. Dilated pupil + absent leg reflexes + slowly reactive to near /accommodation
reflex +poor response to light is= Holmes Adie pupil
Diagnostic test is weak pilocarpine
5..Eye is deviated down and out + ptosis + dilated pupil + unreactive pupil to
light + pain if posterior communicating artery aneurysm is=Third nerve palsy
6. Vesicular rash around eyes + Hutchinson sign i.e. rash on tip or
side of nose is=herpes zoster ophthalmicus
Treatment is oral antiviral ,oral steroids
7.. Red painful eye + photophobia + ephiphora + visual
acuity
decreased+ Fluorescein staining show epithelial
ulcer with dendritic pattern is = Herpes simplex keratitis
Treatment is topical acyclovir Never steroids
8.Nystagmus+ophthalmoplegia+ataxia+alchlocs+
confusion
+ peripheral sensory neuropathy + decrease
red cell transketolase is= Wernicke's encephalopathy
Treatment is thiamine
9. Optic atrophy + contralateral papilledema + anosmia
is=Foster Kennedy syndrome
10. Marfan's syndrome has upward lens dislocation
supratentorial
ectopia lentis
11.Homocystinuria downward inferonasal dislocation of lens
12.Sudden deterioration in vision and flame
haemorrhages in one quadrant is branch retinal vein
occlusion
13.Central vein occlusion involve flame
haemorrhages
in all four quadrants
14.Eye disease seen in alport syndrome is =
Astigmatism
15.Young man + painless loss of vision + visual acuity
fails to improve is = Laber's optic neuropathy
16. optic nerve drusen + progressive loss of
visual perception,
coupled with drusen + geographic atrophy (larger
areas of retinal pigment loss) = Macular
degeneration.
17.investigation of macular degeneration is =
Optical coherence tomography is used to
support the initial diagnosis and to assess
severity of disease.
18.Treatment : Anti-VEGF therapies are the
cornerstone of the treatment of wet age
related macular degeneration to
prevent / delay further neovascularisation.
19.Glaucoma is associated with
enlargement of the blind spot, blurring of
the margins of the optic disc and raised
intra-ocular pressure.
20.Severe hypertensive retinopathy is
associated with retinal haemorrhages.
21.Retinitis pigmentosa presents initially with loss of
night vision, at a much earlier age than 74.
22.Ischaemic optic neuritis associated with pale
swollen optic disc.
23.Optic neuropathy +
proptosis + chemosis +
opthalmoplegia (sixth nerve
palsy )+ blurred vision ptosis
pale optic disk corneal reflex
lost is = Orbital Apex
syndrome
24.Dilated pupil + slowly
responsive to light but reacts
normally to accommodation +
loss of reflex = Holmes Adie
pupil
25.Branch retinal vein
occlusion where there is arc
of haemorrhages treated by
Ranibizumab.
26.In central retinal artery
occlusion give intra arterial
thrombolysis
27.Optic neuritis is
painful visual acuity
improves in week.
28.Homonymous hemianopia
+ afferent pupillary defect +
optic pallor + angiod streaks +
yellow papules on neck +
seizures + memory deficit +
MRI shows bilateral infarcts in
right parieto-occpital area
visual field defect is =
Pseudoxanthoma elasticum
29.Vigabatrin causes visual
field loss blurred vision
,ocilospia tunnel vision.
30.Homonymous
hemianopia with macula
sparing lesion at = Occipital
lobe.
31.Contralateral
homonymous inferior
quadrantanopia lesion at =
parietal lobe.
32. Contralateral
homonymous superior
quadrantanopia lesion at =
temporal lobe. 33.Bitemporal
hemianopia lesion at = optic
chiasm
34.Sudden painless deterioration in vision
coupled with pale retina cherry red spot
at centre of macula is = CRAO
35.Eye pain eye red with ciliary flush
and firm due to raised intraocular
pressure is = acute glaucoma
36.Eye pain gradual deterioration in
vision,color vision either normal
optic disc or evidence of optic disc
swelling is = acute optic neuritis
37.Myopia + sudden appearance of
floaters flashes decreased visual
acuity is = retinal detachment
38.Retinal tears and holes treated by
croyrotherpy or laser
photocoagulation.
39.Floaters+myopia+no
deterioration in vision and
flashes unlike retinal
detachment is = vitreous
detachment
40.Friedreich ataxia = optic atrophy
41.Refsum disease = retinitis pigmentosa
42.Differential
diagnosis of headache + painful diplopia are :
Posterior communicating artery aneurysm
Opthalmogic migraine
Pituitary adenoma
Cavernous sinus thrombosis
Medical mononeuritis
43.optic atrophy ipsilateral eye + papilledema in
contralateral eye + central sctoma in ipsilateral +
Anosmia is = Foster Kennedy Syndrome frontal lobe
44.Ipislteral fixed dilated pupil (3rd nerve )+
contralateral paralysis due to compression of
cerebral pundcle is = Uncal herniation
45.Left homonymous hemianopia
+ afferent pupillary defect + optic
pallor + angiod streaks + yellow
papules on neck + seizures +
mental disturbance is =
Pseudoxanthoma elasticum
46.MRI :bilateral infarcts on
right parieto-occpital area
47.family history/ black patient
/Hypertension /Myopia/ DM +
asymptomatic peripheral visual
loss nasal sctoma loss of nasal
visual field + tunnel decrease visual
acuity + optic disc cupping is =
primary open angle glaucoma
Treatment is = lantoprost 1st line
48.Eye deviated down and out + ptosis + Mydriasis +
unreactive pupil to light is = third nerve palsy
49. Causes of Third Nerve palsy are :
Diabetes mellitus
Vasculitis.
50.Painful or headache + third nerve palsy +
menigism is = posterior communicating artery
aneurysm
51.Ptosis + meiosis = Horner syndrome
52.Ptosis + Mydriasis = third nerve palsy
53.Causes of bilateral ptosis are :
Myotonic dystrophy
Myasthenia gravis
Syphilis Congenital
54.Severe pain ocular headache + decrease visual acuity +
symptoms worse with Mydriasis watching TV dark room +
myadroatic drop causes it + Hard red eye + halos around light +
semi dilated non reactive pupil +eye ball hard to palpate +
hypermetropia is = acute angle closure glaucoma
55.acute glaucoma is diagnosed by : ganiscope
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57.Night blindness initial sign + tunnel vision + black
spicule
shaped pigmentation in peripheral retina mottling
of retinal pigment is = Retinitis pigmentosa
58 Causes of Retinitis pigmentosa are :
Refsum's disease
usher Syndrome
Abetalipoproteinaemia
Lawrence moon bedi syndrome
Kearns Sayre syndrome
Alport syndrome
59.Unilateral decrease in visual acuity over hours and
days + poor discrimination of colures white red looks
paler to on eye than others + relative afferent papillary
defect + central sctoma + accommodation normal + light
reaction is diminished +no sudden loss of vision + no
abnormalities
on Fundoscopy retro bulbar is = optic
neuritis
Diagnosed by MRI of brain
60 .Treatment of Optic Neuritis is : IV methylpredinsone
198
199
200
201
202
203
204
205
IMMUNOLOGY
1.Recurent chest infections + bronchitis +
sinusitis + otitis media + atopic disorder asthma
+ atopic dermatitis + risk of transfusion risk +
coeliac disease is = Selective immunoglobins
2.Recurent pneumonia + abscesses by
(staphylococcus areus,fungi (Aspergilus) +
negative nitroblue tetrazolium test + Abnormal
dihydrohodamine flow cytometry is = Chronic
granulomatous disease Due to lack of NADPH
oxidase
3.Partial albinism +peripheral neuropathy +
recurrent bacterial infections + giant
206 182
granules in neutrophils and platelets =
Chediak higashi syndrome
4.Due to microtubule polymerization defect lead
to decrease in phagocytosis
4.Recurent bacterial infections + delay in
umbilical cord sloughing +absence of
neutrophils pus at sites of infection is =
Leukocyte adhesion defiency Due to defect in
LFA-1 integrin CD18 protein on neutrophils
5.Neutrophils disorders are :
C = chronic granulomatosis disease
C= chediak higashi syndrome
L=Leukocyte adhesion defiency
6.Autoimmune disorder +
lymphoma +
hypogammaglobulinemia is =
Common variable immuno
defiency
7.B -Cell disorders
B =Brutons congenital
agammaglobuminia
C=Common variable immuno defiency
S=Selective immunoglobins A defiency
8.Tetralogy of fallot + learning
difficulties +
Hypocalcaemia + recurrent
viral/fungal disease +
cleft plate is = Digeorge
syndrome22q11.2deltion failure
to develop 3rd,4 th nerve
207 pharyngeal
208
209
210
211
9.T-cell disorder = Digeorge
syndrome
212
213
\
214
215
10.Treatment of hereditary
angioedema is = Transexamic acid
Danzol
anabolic steroids are used for short
term and long term prophylaxis
Acute : IV C1-inhibitor concentrate
and FFP if this is not available
11.Painful macular rash + painless non
pruritic swelling of subcutaneous / sub
mucosal tissues + abdominal pain + No
urticaria + low level of C1-INH is =
Hereditary angioedema
12.Serum C4 is most reliable and
widely used screening tool for
hereditary angioedema
13.Low IgG low igA + respiratory and GIT
infections is = Common variable immuno
defiency
Treatment is : immunoglobins replacement
14.Indications of immunoglobins are :
Primary and secondary immuno defiency
ITP
Myasthenia gravis
GBS
Kawasaki disease
Toxic epidermal nacrolysis
Pneumonitis by CMV
Low serum IgG fallowing stem cell
transplant for malignancy
Dermatomyositis
CIDP
15.recurrent bacterial infections ( chest ) +
eczema + thrombocytopenia is = Wiskott-Aldrich
syndrome
16. Cell Mediated Immune Response –
stimulates production of Interferon Gamma,
Tumour Necrosis Factor Beta and IL 12 which
in turn induces cytotoxic T cell response and
eliminated intracellular organism such as
Listeria
17. Acute Rejection - occurs within
weeks of transplantation and
primarily mediated by host T
lymphocytes that act against donor
MHC antigens. To prevent, administer
Calcineurin Inhibitor
such as Cyclosporine
18.Hyperacute Rejection – that
occurs immediately due to
Preformed Antibodies within the
recipient. This is a Type II
Hypersensitivity Reaction.
19. Natural Killer Cells – are responsible for
killing if MHC I cells fail to respon
d. NK cells are CD16
and CD56, and do not require
Thymus for Maturation. They are
activated by IL 12
20. Adenosine Deaminase – deficient in
SCID and Adenosine accumulates and is
toxic to T lymphocytes.
GENETICS
1.Progressive arthritis which Mimic
osteoarthritis or Ankylosing spondylitis +
urine darkens progressively when left
standing because of high content of
homogenistic acid is = Alkaptonuria
2.Treatment Of Alkaptonuria is : dietary
restriction of tyrosine and phenylalanine
3.Normal female gentila + pubic and axi
llary hair ab
sent + primary Amenorrhea + 46XY + ovaries absent +
undescended testis + bilateral inguinal hernia + testosterone
normal is = androgen insensitivity syndrome
4.Patients with Klinefters with XXY who has subfertility and
wants to father children then = Intracytoplasmic sperm injection
is best
Treatme
5.Pigmented sclera + urine turns black + intervertebral disc
calcification + back pain + renal stones is = Alkaptonuria
nt is :high
dose of vitamin C Dietary restriction of phenylalanine and
tyrosine
6.Upward lens dislocation supratemporal ectopia lentis + blue
sclera ,myopia + Aortic incompetence dilation aortic sinus Aortic
aneurysm ,aortic dissection MVP + mental normal + high arched
plate + tall arm to span ratio 1.05 + pectus excuvtum Dural ecstasy
is = Marfan's Syndrome
7.Treatment of Marfan's Syndrome is :
Beta-blockers
ACEI
8.Down ward dislocation of lens + no aortic incompetence + mental
retardation + atrial and venous thrombosis + malar flush + livedo
reticularis + seizure fine fair hair osteoporosis is = Homocytinuria
9.Investigatin of choice in Homocytinuria is = Cya
nide nitr
oprusside test
10 .Homocytinuria is treated by = vitamin B6 (pyridoxine) Cysthonia
synthase
11.Massive hepatosplenomegaly
+ spleen rapture + bone
weakness osteoporosis +
osteopenia + Aseptic necrosis of
femur + Pancytopenia + bruise
easily + yellow brown skin
pigment + yellow brown papules
(pingueculae) Erlenmeyer flask
shaped cyst + scelrocorneal
junction is = Gaucher's disease
type 1
12.Investigation Of Gaucher's
disease are :
enzyme analysis high tarate
resistant acid phosphatase
hexosomaonses chill trioside
high Alp + ace + immunoglobins
cracked paper
13.X-linked recessive conditions
- no male-to-male transmission
14. X-linked recessive
conditions - there is no
male-to-male transmission.
Affected males can only
have unaffected
sons and carrier daughters.
15 .Klinefilters -
LH & FSH raised
Kallman's - LH &
FSH low-normal
16. Red Ragg
ed Muscle
- is seen on the biopsy in Mitochondrial
Myopathy. This is a mitochondrial disease and
thus only transmitted through mother
17.Vitamin D resistant rickets is x linked dominant.
18. . X linked disorder are :
Becker/Duchene muscular dystrophy
Alport Syndrome
Fragile X
G6PD
Haemophilia A/B.
19.history of alcohol + Bullae develop on sun-exposed areas +Urine:
elevated uroporphyrinogen (Urinary porphyrins)and pink
fluorescence of urine under
Wood's lamp + Porp
hyrins a
re increased in liver, plasma, urine and stool is = Porphyria cutanea tarda
(PCT)
20. 20-40 year olds + abdominal symptoms, neuropsychiatric symptoms
hypertension and tachycardia + peripheral neuropathy + urine turns deep red
on standing + Patients excrete urinary porphobilinogen (PBG) between and
during acute attacks + no photosensivity is = Acute intermittent porphyria
(AIP)
BIOCHEMISTRY &
METABOLISM
1.Ca
uses of Re
spiratory Alkalosis :
Central :stroke , meningitis,CNS tumour
Drugs :aspirin Anxiety
Pregnancy
2.Causes of metabolic alkalosis:
Vomiting
Anorexia Nervosa,
Gastric outlet obstruction
Ingestion of base
Prolonged
hypokalaemia
Burns
Hydroxylation of Lysine to Proline – occurs in RER and requires
Vitamin C
Dietary Energy – 9 kCal per gram of Fat, 4 kCal per gram of
Carbs and Protein and 7 kCal per
gram of Ethanol.
3.Causes of HIGH anion gap acidosis are :
MUDPILES
Methanol
Uraemia
DKA
Paraldehyde
Infection
Lactic acidosis
Sailyctes.
4.Causes of normal anion gap acidosis are :
HARD ASS
H = Hyperalimention
A:addision disease/Ammonium chloride
RTA
Diarrhoea
Acetazolamide
Spironolactone
Saline infusion
5.Niacin – decreases synthesis of triglycerides and VLDL, by suppressing the release of
fatty acids from peripheral tissue. Side Effects are flushing,
which can be prevented by administration Of Aspirin
6. Gluconeogenesis – is a major controller of glucose, during an
overnight fast, where it converts
pyruvate to oxaloacetate and oxaloacetate to phosphoenol
pyruvate
7. Insulin – activated Protein Phosphatase in the cells, and it works
through Tyrosine Kinase
recepto
r in the cells to stimulate synthesis of fatty acids,
protein, glycogen.
8. Patients with Bilateral Cataracts and no Hepatic Involvement –
have a deficiency of Galactokinase and thus Galactose is shifted and
converted into Galactitol by Aldose Reductase
and thus it accumulates in the lens of the eye without Hepatic Involvem
ent
PHYSIOLOGY
1. Glucose Transport – into cells occurs by
Facilitated Diffusion
2. Aldosterone – increase sodium and water
reabsorption in the collecting ducts.
ADH – increases water reabsorption in the
collecting tubule
3. Cortisol – sensitizes vasoconstricitve
effects of
Catecholamines and thus exerts Permissive
Effects on the Vasculature.
Endogenous Administration of Thyroid
Hormone – such as Levothyroxine, will
increase the Free
Levels of T3 and thus in its turn suppress TRH
and then TSH levels.
4.Thyroid Hormones – alter Gene Transcription by Binding to
Receptors Inside the Nucleus.
5. Protein M – is a major Virulence Factor of Strep. Pyogens and
Inhibits Phagocytosis and Complement Activation
6. Sucrose – is a combination of Glucose
and Fr
uctose.
Lactose – is
Maltose – is
Galactose and Glucose
Glucose and Glucose
7 .IGF-1 of the Liver – is responsible for Growth Hormone Effect in
Human Growth
a. IGF -1 from Hypothalamus – is not
Responsible for the Growth, but more
for CNS Activity
8.Transudates (protein < 30gdl or 75% of the serum albumin) are due to:
9. GUT hormones
cholecyst
Reduced intravascular oncotic pressure (hypoalbuminemia)
i. Increased intravascular hydrostatic pressure (cirrhosis,
portal hypertension, CCF)
okinin (duoden
um & jejunum) increases gall bladder contraction, increases
colonic motility.
Gastrin (gastric antrum & duodenum) increases gastric acid secretion,
increases GI mucosal growth.
Secretin(duodenum & Jejunum) increases pancreatic bicarbonate production.
VIP(enteric nerves)increased intestinal secretion, splanchnic vasodilation.
Motilin (whole gut) increases small bowel motility.
Bombesin (gut & Pancreas)stimulates pancreatic exocrine activity.
Neuropeptide Y (enteric nerves)regulates intestinal blood flow.
Somatostatin (stomach & pancre
as) inhibits sec
retion and action of gut hormones. Glucagon(pancreas)reduces GI motility
hyporeflexia is a common clinical sign in patients with hypercalcemia.
Bisphosphonates inhibit bone resorption and are the first line
pharmacological treatment of hypercalcemia of malignancy.
ANATOMY
1.Weakness of shoulder abduction +
numbness over regimental badge area + fits
+ damage to proximal humeral shaft is =
axillary nerve palsy
2.Pain reduced sensation tingling along
anterolateral arm and lateral part of
forearm + reduced power of elbow
flexion + tinnels sign positive is =
musculocutaneous nerve palsy
3.Fall when stopped by grasping fixed
objects in one hand + loss of intrinsic
hand muscle weakness long flexor and
extensor sensory loss medial half of ring
and little finger global wasting of small
hand muscle medial border of forearm
and around elbow is = Klumpkes paralysis
due to damage to t1 and C8
4. Winging of scapula (C5-C7) + shoulder abduction
weakness (C5) + weakness in elbow extension (C5) +
triceps reflex loss(C7) +
sensory los
s lateral shoulder (C5) is = brachial plexopathy
C5-T1
5.Loss of probation of forearm +weakness of
flexor of thumb and index finger is = anterior
interossous nerve
6.Eye deviated down and out + ptosis +
Mydriasis + unreactive pupil to light is = third
nerve palsy
7.Foot drop + dorsiflexion of foot +
eversion of foot + sensory loss over
dorsum of foot , lateral part of leg
spasms 5th toe is = common
peroneal nerve palsy
8.Weakness in plantar flexion +
inversion and decreased ankle jerk
absent is = tibial nerve palsy.
9.Hip flexion + knee extension + knee
reflex + decreased of anterior thigh medial
leg = femoral nerv
e plasy L2
-L4.
10.Ankle inversion + hip abduction is = L5
11.Hip abduction obututor nerve
12.Remember when do of third nerve palsy check 4th also trochleae
which causes in torsion of eye internal rotation of eye effected due to
3rd nerve palsy.
13.Prepatellar Bursa – commonly seen in roofers, carpenters, people who
are kneeling all the time
14. Motor Innervation of the Tongue – provided by Hypoglossal
Nerve
(12), except for palatoglossus
which is innervated by Vagus Nerve (10)
15. Sensation of the Tongue – Anterior 2/3 is Mandibular Branch of
Trigeminal Nerve, Posterior 1/3
is by Glossopharyngeal Nerve (9)
16. 1st Pharyngeal Pouch – external auditory meatus, primary tympanic cavity and
auditory tube
2nd Pharyngeal Pouch – Palatine Tonsils
3rd Pharyngeal Pouch – Thymus, Inferior Parathyroid Gland
4th Pharyngeal Pouch – Superior Parathyroid Gland.
17.Phrenic Nerve – which innervates diaphragm, arises from
C3-C5
18. VPL – receives input from Spinothalamic and is a relay
for Pain, Temperature, Proprioception.
VPM – is a relay for Gustatory Pathways
19. Lateral Geniculate Body – pathway for Vision
Medial Geniculate Body – pathway for Auditory.
Olfactory – doesn’t have a relay through the
Thalamus.
20. Common Peroneal Nerve – is mostly commonly
injured in the trauma near the head of fibula and will
cause Foot Drop.
CELL BIOLOGY
1.Mole
cular
biolog
y
techni
ques:-
SNOW
(South
-
North
-
West)
DROP
(DNA -
RNA -
Protei
n)
2. SER – functions in synthesis of Lipids, Carbohydrate
Metabolism and Detoxification of Harmful substances
3. cAMP pathway - α2, β1 and β2
Inositol Pathway – α1 adrene
rgic, musc
arinic, cholinergic
4. Ribosomal RNA – is synthesized in Nucleolus. It’s the proteins that are
synthesized in RER
5. Phospholipase C - forms IP3 and DAG from phospholipids. And IP3 causes an
increase in
intracellular calcium, which then activates Protein Kinase C.
6. Uroporphyrinogen Synthase – is an enzyme deficient in
patients with Porphyria
7. Retinoblastoma Protein (Rb) – is a regulator of G1 to S phase
transition.
p27 protein – is a cell cycle inhibitor
, so maligna
nt cells will have low number of p27 cells
8.bcl-2 is an inhibitor of apoptosis.
Fas and caspases promote apoptosis but are not
tumour suppressor genes
p53 is a tumour suppressor gene that inhibits mitosis and
promotes apoptosis.
ras is oncogene.
9.p53 = Li -
Fraumeni
syndrome APC
= Colorectal
cancer
BRCA1 = Breast
and ovarian
cancer BRCA2
= Breast and
ovarian cancer
NF1 =
Neurofibromat
osis
R
b
=
R
et
in
o
bl
as
to
m
a
W
T1
=
W
il
m
's
tu
m
o
ur
Multiple tumour
suppressor 1
(MTS-1, p16) =
Melanoma
10. Catabolism of very long chain fatty
acids and amino acids Results in the
formation of hydrogen peroxide occurs at
= Peroxisome
BIOSTATICS
1. 0dds - remember a ratio of the number of people
who incur a particular outcome to the number of
people who do
not incur the outcome, NOT a ratio of the
number of people who incur a particular
outcome to the total number
of people
2. Positive predictive value = TP / (TP + FP)
3. To calculate the Risk – divide the number of diseased
individuals by the total number of patients
in the group.
Mode
mode is the most commonly observed value
Mean
The mean is the average value of observations, and therefore very sensitive to
extreme values in a distribution .
Median it is middle number.
the observation that divides the frequency distribution by half and is equal
to the 50th centile (lies exactly between each end of a range of values.
5. Sensitivity = true positives / (true positives + false negatives)
Specificity = true negatives / (true negatives + false positives
6. Sensitivity TP / (TP + FN ) Proportion of patients with the condition who have a
positive test result
Specificity TN / (TN + FP) Proportion of patients without the condition who
have a negative test result
Positive predictive
value
TP / (TP + FP) The chance that the patient has the condition if the
diagnostic test is positive
Negative predictive
value
TN/(TN+FP)
7. What is the correct formula to calculate the negative predictive value of a screening
test? TN / (TN + FP)
8. Incidence is the number of new cases per
population in a given time period.
Prevalence is the total number of cases per
population at a particular point in time
9. Cohort study Observational and prospective. Two (or more)are selected
according to their exposure to a
particular agent (e.g. medicine, toxin) and followed up to see
how many develop a disease or other outcome.
The usual outcome measure is the relative risk
10. Case-control study Observational and retrospective. Patients with a particular
condition (cases) are identified and matched with controls. Data is then collected
on past exposure to a possible causal agent for the condition.
The usual outcome measure is the odds ratio.
REVIEWS
1.The history of retching followed by bright red
blood in the vomitus and the normal findings
on endoscopy is = Mallory–Weiss tear.
2.treatment of Mallory Weiss tear is =
The patient is haemodynamically stable and
requires no specific intervention save
reassurance and advice on safe consumption
of alcohol.
3.History of codeine use + initial constipation
then profuse diarrhoea + faecal loading on x-ray
+ normal inflammatory markers and normal
WBC is = Overflow diarrhoea
Treatment : oral stool softener like sodium
docusate, switch codeine into meptazinol
Diverticular disease ,Ulcerative colitis
,Clostridium diffcle has high wbcs,raised
inflammatory Marker
4. Management of coaraction of aorta includes
control of
hypertension and assessment for possible
balloon angioplasty +/- stenting or surgical
repair of the lesion.
Linezolid more than vancomycin in
post influenza if fluxoaclin is
contraindicated .
5.Diuretics causes gout so stop it.
6. In osteomyelitis next step is MRI ,once diagnosis is
confirmed then surgical debridement.
7. giant A wave seen in pulmonary stenosis and tricuspid
stenosis .
8.Cardaic arrest occurred and CNS impairment outcomes
improved by period therapeutic hypothermia with respect to
CNS status at discharge.
9.Best next step after chest x-ray for sarcodosis is CT
chest .
More accurate is trans bronchial biopsy
10.Majority of cases e coli recover sponteoulsly
Do not use antibiotics
Post transfusion few days after developed patchie,
purpura, bruises is = post transfusion purpura
Treatment : high dose iv immunoglobins
12.Low IgG + low igA + respiratory and git
infections is = Common variable immuno
defiency
Treatment: immunoglobins replacement.
13.Suspion of celiac disease but
antiendomysial antibody and igA
negative next step is immunoglobins
electrophoresis to exclude isolated
igA defienancy u can do duodenal
biopsy and other tests of caelic
disease after this.
14.Ingestion of amyl nitrate causes
methaeglobimia give methylene blue.
15.Small poorly reactive pupils +
decreased respiratory rate is = opiate
overdose
Give iv naloxone if consciousness doesn't
improve then give intubation ventilation.
1
6
.
P
s
e
u
d
o
m
o
n
a
s
i
n
cystic fibrosis treated by nebulized tobramycin and oral azithromycin
6monthly
17.HIV patient + painless lesion on
glans penis with rolled edges inguinal
lymphadenopathy is syphilis.
18.Nice guidelines recommends that all
patients who present to emergency
department fallowing episode of self
Harm should be offered psychological
assessment
19.Erythema nodsum and u suspected
sarcodosis next step chest chest x-ray not
CT thorax.
20.HIT-2 occurs at 48-72 hour platelets
falls below 100 Treatment: stop LMWH
and change to donaproid or Lepirudin
Hit 1 occur after 5-10 days Rarely
platelets falls below 100 Treatment:
observation and continue LMWH
21.Extrapyramidial signs Parkinson + iv
drug user is = Heavy metal Poisoning.
22.Thyroxine requirements increased by
rifampicin not
INH
23.Antipyschotic/slower onset + low reflexes + lead pipe rigidity + normal
pupils + tachycardia + pyrexia diaphoresis high BP +high Ck + is= neuroleptic
malignant syndrome
Treatment IV fluids Benzodiapines
Dantrolene
Bromocriptine.
24.Tramadol co prescribed with SSRI cause serotonin Syndrome.
25.Agitation + hyponatremia + serotonin Syndrome + hyperpyrexia is =
Cathinone toxicity
Treatment: Benzodiapines,cooling,hypertonic saline if hyponatremia
26.He said he is Jesus bec23
Ecstasy/SSRI/amphetamines/monoamine oxidase inhibitor +
Hyperreninemia, myoclonus, rigidity + fever + altered mental status+
clonus + dilated pupil + faster in onset + tachycardia high BP + high
Ck is = Serotonin Syndrome
Treatment : Iv fluid Benzodiapines
Severe cases cryptoheptadine,chlroprmazine.
27.He said he is Jesus because God spoke to him through TV is = Acute
psychosis which may be related to underlying primary schizophrenia
Treatment: resperidone
28.Nice guidelines for management of painful sickle cell crisis recommends
strong opiate delivered by iv route
29.Manic episode + risk to herself give = IM Lorazapam sedation
If not available then Haloperidol.
30.High PEEP low tidal volume respiratory rate up to 35 is
treatment for ARDS
31.If there is still Diarrhoea after Cholestrayamine use in ileal
resection Crohn's then add codeine phosphate
32.In suspected case of gout therapy in Infective cause 1st is knee
Aspiration
33.In pregnancy and chlamydia give azithromycin not penicillin
34.False beliefs that she some one trying to harm her she z
afraid that they see her and will hurt her she has proves of it like
they keep garbage outside to trap her
Other example is feelings insects crawling over skin =delusions (false
believe)
35.She laughs and giggles for apparent reason and she is unable to
dress or shower herself ,rocking muttering softly herself = Schizophrenia
in disorganized type
36.Unable to eat or drink anything unresponsive both vocally and
nonverbally she resist any attempt to be moved socially isolated
bizarre and speak people no one else could see = Cationic
schizophrenia
37.He has not slept ,bathed ,eaten lack of personal care, in talks to himself
hallucinations is and he says some one stealing his thoughts he fallow
making him unable do school material he is crying feeling of suicide is =
Schizoaffective disorder
38.Hallucinatory voices commanding him to do things hum or laugh
+delusions like girl friend wants to leave him and he has illness won't
live more than 1 year + hallucinations of smell i.e. he smell of fish +
neglect personal hygiene = Paranoid schizophrenia
39.Side effects of Exogenous androgen is paranoid delusions and
aggressive behaviour
40.Sertraline and citalopram appear be safest with antidepressants with
Warfarin
41.Alzheimer's + psychic features like slapping his wife and
inhibitor = give antipsychotics like olanzapine
42.Bilateral femoral bruits and absent dorsalis pedis pulses +
abnormal lipid profile + pain in both calves + pain starts after
walking relieved by rest is = periarterial arterial disease
Treatment: start statin with target LDL of less than 2
43.Buttock and thigh claudication +normal straight leg raise + pain
relieved by rest is = lumbar Spinal stenosis
Investigation is : MRI shows loss of epidural fat on T1 weighted
images loss if csf signal around Dural sac and degernative disc
disease
Treatment : DE compressive lumbar laminectomy first line
surgical intervention
44.Normal straight leg raise in spinal stenosis differentiate it from
other causes of lower limb nerve pain
45.In prolapsed lumbar disc there is pain on straight leg raise
46.Peripheral vascular disease associated
with reduction in
ABPI
47.Long term management in obstructive
sleep apnoea is weight loss
48.In overuse headache stop paracetamol
taper codeine and start naproxen
49.Ventricular bigemini = Reassurance if
she compliant of further episodes of
palpitations then 72 Holter monitor
50. Talc pleurodesis is best for patient of
Mesothelioma with plural effusion
51.Pharyngitis + abnormal LFTs = CMV infection
52.Complicated abscess or those >5 cm in
diameter usually require surgical intervention
to achieve adequate drainage
53.Hypertension + localized cerebellar
signs = Cerebellar haemorrhages.
54.1st line in human bite is = Co amoxiclavline
2nd line metronidazole doxycyciline
55.Best evidence with respect to virus
clearance in hepatitis B is= Entecavir
56.Licorice = low Aldosterone and low
renin
57.HIV patient + mononuclear
Leucocytosis + raised csf +
Ventricular enlargement is =
CMV encephalitis
58.To localize phaeochromocytoma
and not to know that adenoma is
realising catecholamine = MIBG scan
59.Student house +
headache + nausea
vomiting +
confusion vertigo +
pink skin mucosa +
weakness +
arrthymais + coma
+ red lip + lactic
acidosis is = Carbon
monoxide poisoning
Investigation
:pulse oximeter
to measure
level CO
END
Dr.SINBOONA
ARARSA(MD)