lists for medical students
TRANSCRIPT
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ESSENTIAL LISTS FOR MEDICAL STUDENTS
Many medical students find lists an essential tool for revision. The lists displayed here can
be used as a reference guide or as essential revision facts in themselves.
For more lists, see PasTests title Learning by Lists.
CONTENTS
1. CARDIOLOGY1.1 Essential features of atrial fibrillation
1. !linical features of heart failure1." !linical features of mitral #tenosis
2. CLINICAL PHARMACOLOGY.1 $mportant liver en%yme inducers of cytochrome P&'(. E)amples of clinically important drug reactions
." *rug +metabolism in elderly people
3. DERMATOLOGY".1 !auses of +s-in hyperpigmentation
". ail changes in health and disease
4. ENDOCRINOLOGY&.1 !linical features of thyroid disease
&. +!linical features of /cromegaly&." +Essential features of 0ypoadrenalism
5. GASTROENTEROLOGY'.1 Essential features of coeliac disease'. Features of ulcerative colitis and !rohns disease'." Essential features of viral hepatitis
6. GENETICS.1 +!linical features of Marfan syndrome. !onditions inherited in an /utosomal dominant manner
7. GENERAL SURGERY2.1 +!linical features of 3reast cancer
2. !auses of testicular lumps
2." +!linical features of groin hernias
8. HAEMATOLOGY
4.1 +Essential features of $ron deficiency anaemia4. 5aboratory findings in coagulation disorders4." !linical features of #ic-le cell disease
9. HIV
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6.1 7espiratory complications of 0$8
10. IMMUNOLOGY
1(.1 /utoantibodies and disease1(. +Essential features of !7P
11. INFECTIOUS DISEASE11.1 +!linical features of malaria11. +Essential features of 5yme disease
12. METAOLIC1.1 +Essential features of 0ypocalcaemia1. $nterpretation of results in patients 9ith bone disease1." +Essential features of 0yper-alaemia
13. RENAL1".1 $nvestigation of acute renal failure
1". +!linical features of osteodystrophy1"." Management of chronic renal failure
14. NEUROLOGY
1&.1 !lincal features of "rdnerve palsy1&. !linical features of subarachnoid haemorrhage1&." !linical features of !arpal tunnel syndrome
15. OPHTHALMOLOGY1'.1 Eye signs in medical disorders table &1'. *iabetic eye disease
16. RESPIRATORY1.1 +!linical features of !:P*1. +!linical features of T3
1." +!linical features of cystic fibrosis
17. RHEUMATOLOGY12.1 +!linical features of 7heumatoid arthririts
12. /nti;rheumatoid drugs12." +!linical features of 7aynauds phenomenon
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1. CARDIOLOGY
1.1 E!!"#$%&' ("&$)*"! +( &$*%&' (%,*%''&$%+#1. !auses
a. !ardiac
i. M$ and $0*ii. 8alvular heart disease +especially M#iii. !ongenital heart disease
iv. !ardiomyopathy +especially dilatedb. 7espiratory causes
i. PEii. Pneumonia
c. :thersi. 0ypertensionii. 0yperthyroidism
iii. /lcohol +and other drugsiv. $diopathic +&4 hrs after onset or after 9ee-s anticoagulation
ii. *! cardioversioniii. Flecainideiv. #otalol
v. /miodarone
d. 7ate !ontroli. *igo)in ;doesnt control rate effectively alone in active patientsii. 8erapamil
iii. 3eta bloc-erse. Prophyla)is for paro)ysmal /F
i. #otalolii. Flecainide
iii. /miodarone
f. /nticoagulation +ris- of stro-e ";fold
1.2 C'%#%-&' ("&$)*"! +( "&*$ (&%')*"
1. #ymptomsa. 58F
i. #:3
ii. !ough +dry or pin- frothy sputumiii. :rthopnoea and P*iv. !ardiac 9hee%e
b. 78F
i. Peripheral oedema
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ii. /scites. #igns
a. 3iventricular failure
i. 0ypotensionii. Tachycardiaiii. ?allop rhythmiv. *isplaced ape) +dilated heart
b. 58Fi. 3ilateral crepitationsii. Pleural effusions
c. 78Fi. Peripheral oedemaii. 7aised @8P +may have giant 8 9aves if T7iii. 0epatomegaly
iv. /scitesd. !A7 changes in 58F
i. Bpper lobe diversion
ii. !ardiomegalyiii. /lveolar oedemaiv. Cerley 3 linesv. Pleural effusions
1.3 C'%#%-&' ("&$)*"! +( /%$*&' S$"#+!%!1. !auses
a. 7heumatic fever
b. !ongenitalc. !arcinoid syndromed. #5E
. #ymptoms
a. 3reathlessnessb. 0aemoptysisc. Palpitations
d. 7ecurrent chest infectionse. /cute pulmonary oedema
". !linical signsa. Malar flush
b. /Fc. Tapping undisplaced ape)d. :pening snap +mobile valve
e. Mid diastolic murmur
f. Evidence of pulmonary hypertension +T7, 78 heave, 78F&. Treatmentsa. Treat /F +rate control and anticoagulation
b. Endocarditis prophyla)isc. Treat heart failured. 8alvuloplastye. :penDclosed valvulotomy
f. M87
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2. CLINICAL PHARMACOLOGY
2.1 I/+*$$ '%"* "#/" %#)-"*! +( -$+-*+/" P450P! 37/##
1. Phenytoin
2. Carbama%epine
3. arbiturates
4. Rifampicin
5. Alcohol +chronic
6. Sulphonylureas
7. Smo-ing
2.2 E&/'"! +( -'%#%-&'' %/+*$$ *) *"&-$%+#!
D*) D*) E(("-$
/%athioprine /llopurinol Aanthine o)idase inhibition leads to a%athioprineto)icity
/lcohol Metronida%ole!hlorpropamide
Flushing, hypotension
M/:$s Tyramine/lpha;agonists
/mphetamines
/cute hypertensive crisis
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4. Polypharmacy leads to more interactions
3. DERMATOLOGY
3.1 C&)!"! +( "*%/"#$&$%+#1. Metabolic
a. 7enal failureb. !irrhosisc. 0aemochromatosis
. *rugs eg /miodarone". Endocrine
a. /ddisons diseaseb. !ushings syndrome
c. elsons syndrome +hyperpigmentation post;bilateral adrenalectomyd. Pregnancy
&. utritional +Pellegra
'. 5ymphoma
3.2 N&%' -"! %# "&'$ %!"&!"
N&%' -" C&)!"!
Pitting and ridges Psoriasis
:nycholysis Psoriasis:nychomycosis +fungal nail infectionThyroid disease
Trauma
?rooves /cute illness +3eaus linesPsoriasis
5euconychia and hite bands 0ypoalbuminaemia!irrhosis
Gello9 nails Gello9 nail syndrome
Coilonychia $ron deficiency anaemia
#plinter haemorrhages Trauma +commonest cause3acterial endocarditis
!onnective tissue disorders
ailfold telangiectasia !onnective tissue disorders
4. ENDOCRINOLOGY
4.1 C'%#%-&' ("&$)*"! +( $*+% %!"&!"H"*$*+%%!/ H+$*+%%!/
C+#!$%$)$%+#&'
("&$)*"!
eight loss
0eat intolerance/n)iety!lubbing
eight gain
!old intolerance5ethargy0oarse voice
CVS Tachycardia/F
3radycardiaPericardial effusion
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!ardiac failure !ardiac failure
S%# 0air loss
#9eatingPretibial my)oedema +?raves
0air loss
*ry s-inPuffy face
M"#!$*)&' /menorrhoea Menorrhagia
GI *iarrhoea !onstipation
CNS TremorPro)imal myopathyPsychosis
#lo9 rela)ing refle)es*epressionPoor memory
!arpal tunnel syndrome
Bloods T" T&
T#0Microcytic anaemia
T" T&
T#0Macrocytic anaemia
T*"&$/"#$ 3eta 3loc-ers!arbima%ole
7adioactive $odine#urgery
Thyro)ine
4.2 C'%#%-&' ("&$)*"! +( A-*+/"&' H"*!"-*"$%+# +( GH:1. 6'H due to pituitary tumour
. *iagnosisa. Failure of ?0 to suppress to oral glucose load may get parado)ical rise.b. 7aised serum $?F;1 levelsc. 8isual fields
d. M7$ pituitary". Features
a. E)amination
i. !oarse facial appearance
ii. 5arge hands D feet D hat si%eiii. Enlarged lo9er a9iv. !arpal tunnel syndrome
v. 0yperhydrosisvi. /rthropathy
b. Metabolici. 0ypertension
ii. *iabetes mellitusc. !ardiorespiratory
i. $ncreased cardiovascular mortality
ii. :bstructive sleep apnoeaiii. 580 and cardiomyopathy
d. :thersi. 7enal stones
ii. $ncreased ris- of colon cancer&. Treatment
a. Pituitary surgery
b. :ctreotide +somatostatin analoguec. Pituitary irradiationd. 3romocriptine.
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i. *ermatitis herpetiformis. 0yposplenism
k. !aD:steomalaciaDosteoporosisl. $g/ deficiency +'H
. *iagnosis
a. *uodenalDeunal biopsy; intraepithelial lymphocytes, villous atrophyb. Tissue transgluaminase +tT? /bs most accuratec. Endomysial /b
2. Treatmenta. ?luten free diet ; " month recovery of villous atrophy
b. Treat deficienciesc. #creen for and treat osteoporosis
5.2 F"&$)*"! +( C*+#;! %!"&!" )'-"*&$%" -+'%$%!
C*+#;! %!"&!" U'-"*&$%" -+'%$%!
1. /ffects any part of the ?$ tract frommouth to anus.
. !ommonly terminal ileum, colon,anorectum.
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1. !olonoscopy and biopsy. 3arium studiesL
a. !obblestoning of mucosab. 7ose thorn ulcers
c. #-ip lesions". $sotope leucocyte scans useful to
diagnose active small bo9el disease
1. !olonoscopy and biopsy. 3arium studiesL
a. Pseudopolypsb. 5oss of haustral pattern
c. Featureless shortened colon
C+/'%-&$%+#!
1. FistulaeLa. entero;enteral
b. entero;vesicalc. entero;vaginald. perianal
. !arcinoma ; slightly increased
incidence of colonic malignancy". /bscess formation
1. Fistula do not develop. To)ic megacolon +urgent indication for
colectomy
3. $ncreased incidence of carcinoma;(after (years of disease
&. Preventative colectomy of value'. $ron deficiency anaemia
T*"&$/"#$
5ASA -+/+)#!< +eg mesala%ine :ral and topical treatment for flares of diseaseand prevention of relapses
S$"*+%!< Topical, oral or parenteral for treatment of flare up +not maintenance
A&$%+*%#"
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Fulminant hepatitisrare.!hronic 0!8 cansuccessfully be
treated 9ithinterferon andribavirin +'(Hresponse
+chronic 0!8+"(H ris- ofcirrhosis after "(years of infection.
0igh ris- of 0!!.
* 3lood.
*ependantonconcurrent038
infectionforreplication
$ncom
plete
E)acerbates
038 infectionand increasesris- of hepaticfailure and
cirrhosis
$nterferon of limited
benefit
$ncreases incidence
of cirrhosis inchronic 038
E Faecal;oral 7/ /symptomatic@aundiceMalaiseausea
#upportive/cute self limitingillness$n pregnancy
mortality +fetal andmaternal of ' H
o
6. GENETICS
6.1 C'%#%-&' ("&$)*"! +( M&*(! !#*+/"
1. Mutation of fibrillin +constituent of connective tissue !hromosome 1'. Features
a. Tall stature +armspan heightb. /rachnodactyly +long fingers
c. 0igh arched palated. #coliosise. 0ypere)tensile oints
f. Bp9ard lens dislocationg. /ortic root dilatation +/7, aortic dissectionh. Mitral valve prolapse and M7
6.2 C+#%$%+#! %#"*%$" %# A)$+!+/&' +/%#$ /#"*
1. /dult polycystic -idney disease. ?ilberts syndrome
". 0untingtons chorea&. 0ereditary spherocytosis'. Marfans syndrome. Myotonic dystrophy
2. eurofibromatosis4. oonans syndrome
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6. :steogenesis imperfecta1(. Familial Polyposis coli11. Tuberous sclerosis
1. 8on illebrands disease.
7. GENERAL SURGERY
2.1 !linical features of breast cancer1. /denocarcinoma
a. *uctal carcinoma 6(Hb. 5obular carcinoma 1(H
. Most common cancer in 9omen". 1H of breast cancer occurs in males
&. 7is- factorsa. /dvanced ageb. Family history +particularly mother and sister
c. orth /merica or northern European descentd. 0igh postmenopausal blood oestrogen levele. 0igh socioeconomic statusf. /ge at first full;term pregnancy older than "( years
g. 0istory of cancer in the other breasth. /ny first;degree relative 9ith a history of breast canceri. ulliparity
. 0istory of endometrial or ovarian cancer
'. ?eneticsa. 37!/1 and mutations confer increased ris- of breast cancerb. "H of the breast cancer population have 37!/ 1 +2(H of 9omen 9ith early;onset
breast cancer
c. 2( H of subects 9ith 37!/1 develop breast cancer in their life timed. 37!/ lifetime ris- is ';"(H
6. Presentationa. May be asymptomatic and diagnosed by screening mammographyb. Painless palpable breast lump
i. !linical characteristics of malignant breast lumps1. $rregular hard lump
. Bsually painless". :ften fi)ed to the s-in or chest 9all&. #-in dimpling
'. ipple retraction
. 3loody dischargeii. !haracteristics of 3enign lumps +4(H of breast lumps
1. Firm regular rubbery mass
. :ften painfulc. ipple discharged. Pagets disease of the nipple
e. Peau dorange2. *iagnosis
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a. Mammographyb. Bltrasoundc. Fine needle aspiration
d. !ore biopsye. :pen biopsyf. !T and bone scan to loo- for metastases
4. Treatment +dependant on stage, comple) and constantly being optimised
a. 5umpectomyb. Mastectomyc. Mastectomy and a)illary clearance
d. 7adiotherapye. /duvent chemotherapy +constantly evolvingf. 0ormonal therapy +for oestrogen receptor positive disease
i. Tamo)ifen
ii. /nasta%ole
7.2 C&)!"! +( $"!$%-)'&* ')/!
1. Painlessa. 0ydrocoeleb. 8aricocoelec. #permatocoele
d. Epididymal cyste. Testicular cancer +sometimes
i. #eminomasii. Teratoma
iii. Mi)ed seminoma;teratomaiv. 5ymphomav. Gol- sac tumours
. Painful
a. Epididymo;orchitisb. Torsionc. #ome testicular cancers
d. 0ernias
7.3 C'%#%-&' ("&$)*"! +( *+%# "*#%&!1. $ndirect inguinal +(H
a. 0erniation that e)tends do9n the inguinal canal and may enter the scrotumb. Failure of the obliteration of the processus vaginalisc. Medial and above the pubic tubercle
d. Bsually has a cough impulse
. *irect inguinal +'Ha. ea-ness in the abdominal 9all due to increased abdominal pressureb. Protrudes through transversalis fascia in the posterior 9all if the inguinal canal
c. Medial to the inferior epigastric vessels". Femoral +1'H
a. More common in 9omenb. Passes do9n the femoral canal
c. 5ateral to the pubis tubercled. !ommonly becomes incarcerated leading to small bo9el obstruction
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". 0b# becomes insoluble and leads to cell sic-ling in hypo)ic conditions&. !ommon in blac- /fricans'. 7educed susceptibility to falciparum malaria
. 0etero%ygotes 0b/# N sic-le cell traita. Mild often asymptomatic. May get sic-ling under ano)ic conditions
2. 0omo%ygotes 0b## N #ic-le cell diseasea. !hronic haemolytic anaemia
b. 7ecurrent crises4. #ic-le cell crisis precipitated by
a. 0ypo)ia
b. $nfectionc. *ehydrationd. #ystemic illness
6. Features of crisis
a. Pain due to bone marro9 infarctionb. #ic-le dactylitis infarction of small bones of hands and feetc. #plenic infarction leads to hyposplenism
d. Thrombotic stro-ee. 7etinopathyf. Pulmonary infarction;chest syndromeg. Priaprism painful sustained erection
1(. :ther featuresa. /plastic crisis usually precipitated by parvovirus 316 infectionb. /vascular necrosis of nec- of femurc. 5eg ulcers
d. ?allstones +pigmented due to haemolysis11. *iagnosis
a. 0aemoglobin elecropheresis
b. 3lood film anaemia, sic-le cells, increased reticulocyte count, target cells
c. Positive sic-ling test
9. HIV
9.1 R"!%*&$+* -+/'%-&$%+#! +( HIV1. 8iral infections
a. /denovirusb. $nfluen%ac. !M8
. 3acterial
a. Streptococcus pneumoniaeb. Staphylococus aureusc. Tuberculosis
i. !ommon presentationii. E)tra pulmonary disease commoniii. *oes not tend to have classical !A7iv. Multi;drug resistance is more common
v. /typical mycobacterium infections occur e.g M. avium complexvi. !an occur 9ith any !*& count
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". Pneumocystis carinii pneumoniaa. !ommon presentationb. Bsually occurs 9hen !*& >((
c. /bnormal !A7 in 6(Hd. 0ypo)ice. *ry cough, fever, malaisef. Treatment is 9ith high dose co;trimo)a%ole
&. Fungala. !andidab. Histoplasmosis
c. !ryptococcus
10. IMMUNOLOGY
10.1 A)$+$%,+%"! %!"&!"
D%!"&!" A#$%"#
0ashimotos thyroiditis ThyroglobulinThyroid pero)idase
?raves disease T#0 receptor
Pernicous anaemia $ntrinsic factor Parietal cell
/ddisons disease /drenal corte) cells
$**M !ytoplasm of islet cell
$nsulin?lutamic acid decarbo)ylase +?/*
Myasthenia gravis /cetyl !holine receptor
5ambert Eaton syndrome !a channels on nerve endings
?ullain;3arre syndrome Peripheral nerve myelin components?oodpastures syndrome ?lomerular and lung basement membrane
/$ haemolytic anaemia Erythrocytes
$TP Platelets
P3! Mitochondria
#ome male infertility #permato%oa
10.2 E!!"#$%&' ("&$)*"! +( CRPBseful in monitoring inflammation/cute phase reactant produced mainly in the liver
7ises 9ithin hoursFalls in ;" days
Mar-ed elevation3acterial infection
/bscess!rohns disease!onnective tissue diseases +e)cept #5Eeoplasia
Traumaecrosis
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ormal or slight elevation8iral infection#teroidsDoestrogens
B!#5E
11. INFECTIOUS DISEASE
11.1 C'%#%-&' ("&$)*"! +( /&'&*%&
!aused by the proto%oanplasmodiumsp#pread by bite of female anophelesmosIuito& types
3enign
8iva):valeMalariae
MalignantFalciparum
!linical features
Fever 9ith drenching s9eats7igors0eadacheMyalgia
* and 83enign malaria is not life threatening and is treated 9ith chloroIuine for " days follo9ed by
primaIuine for 9ee-s +eradicate liver cycle
Falciparum malaria
!omplications!erebral malaria +Bp to 1(H mortality0aemolytic anaemia
Metabolic acidosis0ypoglycaemia/cute renal failurePulmonary oedema
0igh parasite count N more severe diseaseTreatment
:ral or $.8. Juinine
/lternatives include Malarone, MefloIuine
*iagnosis#erial thic- and thin films7apid antigen tests
:ther results/naemiaThrombocytopenia0ypoglycaemia
/bnormal coagulation
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Remember always to consider malaria in patient who has travelled to malariaous area evenif they have taken prohpylaxis
11.2 E!!"#$%&' ("&$)*"! +( L/" D%!"&!"
1. Tic-;borne disease ; most common in B#/
2. /etiologic agent is the spirochete orrelia burgdorferi". Transmitted from animals to humans by harbouring infected tic-s&. Typically divided into " clinical phasesL
a. Early local disease
i. Fever, malaiseii. /rthralgia +oint painiii. Myalgia +muscle pain
iv. 0eadachesv. Erythema migrans target lesion sat site of tic- bite
b. Early disseminated diseasei. :ccurs 9ee-s to months after initial infection
ii. eurological disease +especially meningitis and 3ellOs palsyiii. Myocarditisiv. /rthropathy 9ithout oint effusion
c. 5ate disseminated disease +previously called #tage "
i. :ccurs months to years after initial infectionii. Typified by chronic arthritis andDor encephalopathy +sleep disturbances,
fatigue, personality changes.
12. METAOLIC
12.1 E!!"#$%&' ("&$)*"! +( +-&'-&"/%&
1. !ausesa. 0ypoparathyroidismb. !hronic renal failure
c. 5o9 levels of vitamin *"d. 0yperphosphataemiae. 0ypomagnesaemiaf. #epsis
g. 7espiratory al-alosish. !alcium deposition + eg acute pancreatitisi. !arcinoma of prostate
. Features
a. Muscle 9ea-nessb. euromuscular e)citabilityc. !onfusion
d. #ei%urese. Tetanyf. !ataracts
g. *ental hypoplasia". Treatment
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a. #upplementation of calcium, vitamin *"
12.2 I#$"**"$&$%+# +( *"!)'$! %# &$%"#$! =%$ ,+#" %!"&!"
*isease !a P:& /5P PT0
0yperparathyroidism
+primary or or
0ypoparathyroidism
:steoporosis
:steomalacia
Pagets
7enal failure or
12.3 E!!"#$%&' ("&$)*"! +( "*&'&"/%&1. !auses
a. #purious
i. 0aemolysisii. E)cessive inta-e +parenteral, oral
b. *ecreased e)cretioni. /cute oliguric renal failure
ii. !hronic renal failureiii. *rugs
1. #pironolactone
. /miloride". /!E inhibitors&. #/$*#
iv. /ddisonQs disease
v. 0ypoaldosteronismc. 7edistribution
i. /cidosisii. 7habdomyolysis
iii. Tumour lysis syndromeiv. *igo)in poisoning
. E!? changes
a. Tenting of T 9avesb. 7eduction in si%e of P 9avesc. $ncrease in P7 intervald. idening J7# comple)es
e. *isappearance of P 9avesf. #inusoidal 9aveform
". Treatment
a. $8 calcium gluconate +stabilises cardiac membranesb. $8 insulin and de)trosec. !alcium resoniumd. Frusemide
e. #albutamol nebulisersf. *ialysis
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13. NEPHROLOGY
13.1 I#"!$%&$%+# +( A-)$" R"#&' F&%')*"1. Full history and e)amination
a. R #ystemic causeb. *rug history;penicillin or #/$*#
c. Family history. Bltrasound scan
a. 7ule out obstruction
b. Cidney si%e +if small then acute on chronic". Brine
a. Microscopy of urine +pgRb. !ulture and sensitivity
c. Proteind. 0aematuriae. !asts
f. 3ence;@ones protein ; myeloma&. $8B +$ntravenous Brogram or !T to loo- for nephrolithiasis'. $sotope renography
a. #tatic e.g. *M#/
b. *ynamic e.g. M/?", *TP/c. !aptopril renogram to loo- for renovascular disease
. 3lood testsa. #pecific
i. /nti;?3M antibodies ?oodpastureQs diseaseii. /!/ #ystemic vasculitis
iii. /nti;ds*/ S/nti;#m #5E
iv. !" nephritic factor Mesangiocapillary? type
v. /#:T and /nti;*/ase Post streptococcal ?vi. 3lood cultures $nfection, especially endocarditis
b. 5ess #pecific
i. !omplement 0igh in vasculitis5o9 in #5E
ii. $mmunoglobulins Polyclonal increase in #5E and vasculitis.Monoclonal increase in myeloma.7aised $gE in !hurg;#trauss.7aised $g/ in 0enoch;#cholein purpura and
$g/ nephropathy
iii. !ryoglobulins !ryoglobulinaemiaiv. !7P $ncreased in most cases but not usually in #5E
v. Eosinophilia *rug induced interstitial nephritis!hurg;#trauss syndrome
vi. 5ymphopenia #5E
13.2 C'%#%-&' ("&$)*"! +( O!$"+!$*+1. 3one disease that results from the metabolic disturbance in renal failure
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2. Pathophysiologyi. 5o9 plasma ioni%ed calcium
ii. *ue toL1. lac- of 1, ' dihydro)yvitamin *. Malabsorption of calcium". 0yperphosphataemia +failure of e)cretion
b. #timulation of Parathyroid hormone release +#econdary 0yperparathyroidismi. *ue toL
1. 0ypocalcaemia. 0yperphosphataemia
". 5o9 1,' *i; +:0 8it *&. /cidosis
". !linical features
a. :steoporosisb. :steomalaciac. /reas of osteosclerosis +rugger;ersey spine
&. Treatment
a. Phosphate binders +e.g. calcium acetateb. 8itamin * +1;alphacalcidolc. Parathyroidectomy
13.3 M&"/"#$ +( C*+#%- R"#&' F&%')*"
1. 3lood pressure control +aim for >1"(D2'a. /!E inhibitorsb. :ther anti;hypertensives
c. *iuretics. 7eduction in proteinuria
a. /!E inhibitors
3. Treatment of anaemia +maintain 0b1(a. $8 ironb. Erythropoetin
&. *ieta. 5o9 salt inta-eb. 5o9 Potassium inta-ec. 0igh !alorie inta-e
5. Treatment of hyperphosphatemia and hypocalcaemia +renal bone diseasea. Phosphate 3indersb. /lphacalcidol
. ?lucose control in *iabetics
2. !ontol hyperlipidaemia
4. 8olume #tatus monitoring6. /void nephroto)ic *rugs
14. NEUROLOGY
14.1 C'%#%-&' ("&$)*"! +( $%* #"*" &'!
1. "rdnerve supplies all the e)traoccular muscles e)cept superior obliIue and lateral rectus
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. !arries parasympathetic pupiloconstrictor fibres". ucleus in pons&. Features
a. *ilated unreactive pupilb. Ptosisc. $nability to move the eye superiorly, inferiorly, mediallyd. Eye do9n and out at rest
'. !ausesa. 8ascularD*iabetesDdemyelinationDtraumab. Posterior communicating artery aneurysm
c. !avernous sinus thrombosis,d. :rbital tumoure. Thyroid eye diseasef. Trauma
14.2 C'%#%-&' ("&$)*"! +( !),&*&-#+% &"/+**&" SAH:
1. !ausesa. 7upture of aneurysm 4(H anterior circulation +mainly ant. communicating
arteryb. 0ypertension
c. /rterio;venous malformationd. Traumae. !ocaine or amphetamine abuse
. #ymptomsa. 0eadache +sudden onset and severeb. 8omitingc. !oma.
". *iagnosis
a. !T scan +6(H diagnostic yieldb. 5umbar punctureL
i. )anthochromia +& hours post episode, clears after 9ee-s
ii. U blood cell count on microscopy +unreliable as (H taps are traumaticc. !T /ngiographyDM7 angiographyD cerebral angiography to find aneurysms
&. Treatment
a. imodipine reduces vasospasm
b. eurosurgical clipping of aneurysm.c. Endovascular embolisation of aneurysm
'. Prognosis
a. "(H mortality from first episode.
. !onditions associated 9ith #/0a. Polycystic -idney diseaseb. Ehlers*anlos syndrome
c. Marfans syndromed. eurofibromatosis type 1
14.3 C'%#%-&' ("&$)*"! +( -&*&' $)##"' !#*+/"1. Median nerve palsy +nerve compressed at 9rist
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. Featuresa. Pain and parasthesia +9orse at nightb. Parasthesia of lateral "V fingers
c. ea-ness of 5:/F musclesL
i. Lateral lumbricals
ii. Opponeus pollicis
iii. Abductor pollicis
iv. Fle)or pollicis brevis". /ssociations +P0/7:L
a. Pregnancy
b. Hypothyroidism
c. Acromegaly
d. Amyloidosis
e. R/
f. Obesity&. $nvestigation
a. Tinels sign tapping on nerve causes tingling
b. Phalens sign prolonged fle)ion of 9rist leads to tinglingc. erve conduction studies
'. Treatment
a. #plinting of 9ristb. #teroid inection to fle)or retinaculumc. #urgical decompression.
15. OPHTHALMOLOGY
1'.1 Eye signs in medical disorders
S%# D%!+*"*3itot spots 8itamin / deficiency
3lue sclera :steogenesis imperfecta
Pseudo)anthoma elasticumEhlers;*anlos syndromeMarfans syndrome0yperthyroidism
3rushfield spots *o9ns syndrome
!orneal arcus 0ypercholesterolaemia +type a and b
:ld age
!orneal calcification #arcoidosis0yperparathyroidism!hronic renal failure8itamin * abuse
Cayser;Fleischer rings ilsons disease
5isch nodules eurofibromatosis
7oth spots #ubacute bacterial endocarditis
5eu-aemia*iabetes
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15.2 D%&,"$%- E" %!"&!" /+!$ -+//+# -&)!" +( ,'%##"!! %# &$%"#$! &" 3060:1. 3ac-ground retinopathy
a. 8isual acuity unaffected
b. Microaneurysmsc. 0aemorrhagesd. 0ard e)udates
. Pre;proliferative retinopathy
a. !otton 9ool spotsb. *ilatation and beading of retinal veinsc. $ntraretinal microvascular abnormalities
3. Proliferative retinopathy +more common in type 1 diabeticsa. eovascularisationb. Treated cases 9ill have panretinal laser burns
&. /dvanced diabetic eye diseasea. 8itreous haemorrhageb. Tractional retinal detachmentc. 7ubeotic glaucoma
5. Maculopathy +more common in type diabeticsa. :edema and e)udatesb. Macular #tars +multiple e)udatesc. 5oss of central vision +peripheral spared
. Treatmenta. ?ood diabetic controlb. Treat hypertensionc. #top smo-ing
d. Treat hypercholesterolaemiae. 7egular fundal e)aminationf. Focal retinal photocoagulation
g. Panretinal photocoagulation
16. RESPIRATORY
16.1 C'%#%-&' ("&$)*"! +( C*+#%- O,!$*)-$%" P)'/+#&* D%!"&!" COPD:1. !hronic progressive disorder characterised by fi)ed airflo9 obstruction that does not
change mar-edly over several months
. Main aetiological factor is smo-ing". Patients have varying degrees of chronic bronchitis and emphysema&. !hronic bronchitis is a clinical diagnosis of productive cough for " months in
consecutive years
'. Emphysema is an pathological diagnosis 9ith destruction of the acinus +but features canbe seen on !T
. Mar-ed morbidity D mortality
2. !linical featuresLa. cough +usually productiveb. #:3
c. hee%ed. 7ecurrent e)acerbations
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P%# )(("* ')" '+&$"*
0yperventilation 0ypoventilation
!:+type 1 resp failure !:+type resp failure
3reathless but not cyanosed !yanosed but not breathless
!or pulmonale
8. FE81D F8! ratio > 2'HW FE81> 4(H of predicted6. Treatments
1(. /cute as for asthma but o)ygen therapy must be controlled as some patients havetype respiratory failure
11. !hronic
a. #topping smo-ing +:nly measure that 9ill slo9 progressionb. $nfluen%a and pneumococcal vaccine
c. Mild disease +FE81(;4(Hi. #hort acting 3eta agonist or ipratropium as reIuired
d. Moderate +FE81&(;'6Hi. 7egular #hort acting 3eta agonist or ipratropium
ii. !onsider corticosteroid trial, if reversibility +1' H improvement in FE81thengive steroid inhaler
e. #evere + FE81>&(Hi. ebuliser trialii. !onsider long term o)ygen therapy
1. !omplicationsa. 7espiratory failureb. 7ecurrent
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a. idespread haematological spread of bacilli'. #ymptoms
a. ight s9eats
b. eight lossc. !oughd. 0aemoptysise. Pleural effusion
f. Meningitis. *iagnosis
a. !A7 +upper lobe shado9ing, loss of volume, cavitation
b. #putum e)amination for acid;alcohol fast bacilli +//F3sc. Early morning urine for //F3sd. 5ymph node biopsye. 3one marro9 aspirate
f. 3ronchoscopy and lavageg. !ulture ta-es at least 9ee-s
2. Treatment
a. Triple therapy 9ith rifampicin, isonia%id and pyra%inamideb. /dd ethambutol for those 9ith 0$8 or from area associated 9ith resistancec. Triple D Iuadruple therapy for months, rifampicin D isonia%id further & monthsd. !ompliance very important
e. #ide effects commoni. 7ifampicin
1. 0epatitis. ausea
". Pin- D orange urine&. En%yme inducer
ii. $sonia%id
1. 0epatitis
. Peripheral neuropathy +cover 9ith pyrido)ineiii. Pyra%inamide
1. 0epatitis
. 7ash". ?out
iv. Ethambutol1. :ptic neuritis
. 7enal dysfunction
16.3 C'%#%-&' ("&$)*"! +( -!$%- (%,*+!%!
1. /utosomal recessive
. 1 in ' adults carriers". $ncidence 1 in ((( live births&. ?ene on long arm of chromosome 2 codes for cystic fibrosis transmembrane regulator
protein +!FT7
5. "((K mutationsW commonest is deletion of " bases called '(4 +4H of cases. *efect of chloride and 9ater transport across epithelial cell membrane
2. *iagnosis by s9eat testW sodium and chloride concentrations ( mmol D l4. 5ife e)pectancy improving + &(yrs.6. 7espiratory features
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a. :bstruction of small air9ays 9ith thic- mucus due to chloride secretion and sodium resorption leading to bronchiectasis
b. !olonisation 9ith S. aureus! H. "nfluen#ae! Pseudomonas aeruginosa.andurkholderia cepacia
c. Treat 9ith antibiotics, acutely and prophylactically1(. ?astrointestinal features
a. Pancreatic insufficiency in 4(Hb. Meconium ileus in infancy, small bo9el obstruction in adultsc. !hronic liver disease seen due to biliary obstructiond. ?allstones
e. Pancreatitis11. :ther features
a. *iabetes + "(H of patients in late teensb. Pneumothora) +'H
c. $nfertility +almost all mend. :steoporosis
17. RHEUMATOLOGY
17.1 C'%#%-&' ("&$)*"! +( *")/&$+% &*$*%$%!
1. This is an autoimmune chronic inflammatory polyarthropathy. 7evised /merican !ollege of 7heumatology criteria for the classification of rheumatoid
arthritis +1642 +7/ if at least & of the 2 criteriaa. Morning stiffness +1hr for 9-s
b. /rthritis of N" oint areas for 9-sc. /rthritis of the hand oints for 9-sd. #ymmetrical arthritis
e. 7heumatoid nodulesf. #erum rheumatoid factorg. 7adiographic changes
". @oint involvement in 7/
a. #ymmetrical polyarthropathy affectingL
i. M!P 6(Hii. P$P 6(H
iii. MTP 6(H
iv. rists 4(H
v. Cnees 4(H
vi. /n-leDsubtalar 4(Hvii. #houlder (H
viii.0ip '(Hix. Elbo9 '(H
x. !ervical spine &(H&. Features of rheumatoid hands
a. #ymmetrical deforming polyarthropathy affecting M!P, P$P and 9rist oints
b. #pares *$Pc. /ctive oints are hot, s9ollen and tender.d. Blnar deviation at M!P
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e. #ublu)ation at M!P and 9ristf. #9an nec- deformityg. 3utonniere deformity
h. X deformity of thumbsi. asting of dorsal interossei
. /bsence of psoriatic nail changes-. ail fold infarcts or vasculitic lesions
l. Evidence of carpal tunnel syndromem. Palmer erythema
'. E)tra;articular features of 7/
a. on;organ specifici. eight lossii. Fever iii. 5ymphadenopathy
iv. 7heumatoid nodules +patients 9ill be rheumatoid factor Kvev. Feltys syndromevi. /myloidosis
vii. $ncreased susceptibility to infectionsviii.:steoporosis
b. :rgan #pecifici. !ardiac
1. Pericarditis and effusion. 8alvular heart disease
ii. Pulmonary1. Pleurisy
. Pleural effusion". $nterstitial fibrosis&. odular lung disease
'. 3ronchiectasis
. !aplans syndrome +nodules and progressive massive fibrosis in coal9or-ers
iii. eurological
1. !ompressive neuropathies eg carpal tunnel syndrome. Mononeuritis multiple) +vasculitis". !ervical myelopathies
iv. 7enal
1. /myloidosis. *rug induced glomerulonephritis or interstitial nephritis
v. :cular
1. Episcleritis and #cleritis
. #cleromalacia perforans". #ogrens #yndrome. 5aboratory findings in 7/
a. /naemia; normochromic or hypochromic, normocyticb. Thrombocytosisc. 7aised E#7d. 7aised !7P
e. 7aised ferritinf. 5o9 iron concentration
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iv. *rug induced lupusv. Myasthenia gravisvi. Thrombocytopena
vii. Pancytopenia&. #ulpha%ala%ine
a. #ulphapyridine +active molecule decreases inflammatory reactions and systemicallyinhibits prostaglandin synthesis.
b. #ide effectsi. auseaii. #-in rashes
iii. 0epatitisiv. Pulmonary eosinophiliav. 0aemolytic anaemiavi. Pancytopenia
vii. 7educed sperm +reversible'. Methotre)ate
a. Folic acid antagonist cytoto)ic drug
b. 3inds to dihydrofolate reductase and interferes 9ith */ synthesis and cellreplication
c. #ide effectsi. 0epatic fibrosis
ii. 3lood dyscrasias. !yclophosphamide
a. Po9erful immunosupressant that reduces both antibody mediated and cellmediated response
b. #ide effectsi. 0aemorrhagic cystitisii. Pancytopenia
2. /%athioprine
a. $nhibits nucleic acid synthesis, suppressing cell;mediated hypersensitivity andaltering antibody production.
b. #ide effects
i. 3one marro9 suppressionii. !holestatic hepatitisiii. ausea and vomitingiv. Pancreatitis
17.3 E!!"#$%&' ("&$)*"! +( R&);! "#+/"#+#1. Episodic event characterised by the digits turning 9hite and numb, then cyanosed and
finally red and painful +rebound hyperaemia
. ";1(H of adults affected". 1H of 7aynauds sufferers have a connective tissue disorder&. !auses
a. $diopathicb. !onnective tissue disordersc. !ervical ribd. $ncreased plasma viscosity
e. *rugs; 3eta bloc-ersf. 8ibrating instruments
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'. Treatmentsa. armthb. o smo-ing or 3eta bloc-ers
c. !alcium channel bloc-ersd. ?Te. Prostacyclin infusion