Dr_SINBOONA_ARARSA_KENENI_SHORT_PEARLS_ON_MEDICAL_CASES_EDITION

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

tr

e

at

m

e

nt

of

ac

ut

e

gl

a

u

c

o

m

a

is

:

IV

a

n

al

g

es

ia

,

Antiemetic

t

o

p

i

c

a

l

p

i

l

o

c

a

r

p

i

n

e

A

c

e

t

a

z

o

l

a

m

i

d

e

I

V

+

p

i

l

o

c

a

r

p

i

n

e

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)

Dr_SINBOONA_ARARSA_KENENI_SHORT_PEARLS_ON_MEDICAL_CASES_EDITION

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?