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. CARDIOLOGY 1.1 Essential features of atrial fibrillation 1. !linical features of heart failure 1." !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 1.1 +!linical features, of Marfan syndrome 1. !onditions inherited in an /utosomal dominant manner 7. GENERAL SURGERY 2.1 +!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 anaemia 4. 5aboratory findings in coagulation disorders 4." !linical features of #ic-le cell disease 9. HIV

6.1 7espiratory complications of 0$8 10. IMMUNOLOGY 1(.1 /utoantibodies and disease 1(. +Essential features of, !7P 11. INFECTIOUS DISEASE 11.1 +!linical features of, malaria 11. +Essential features of, 5yme disease 12. META OLIC 1 .1 +Essential features of, 0ypocalcaemia 1 . $nterpretation of results in patients 9ith bone disease 1 ." +Essential features of , 0yper-alaemia 13. RENAL 1".1 $nvestigation of acute renal failure 1". +!linical features of , osteodystrophy 1"." Management of chronic renal failure 14. NEUROLOGY 1&.1 !lincal features of "rd nerve palsy 1&. !linical features of subarachnoid haemorrhage 1&." !linical features of !arpal tunnel syndrome 15. OPHTHALMOLOGY 1'.1 Eye signs in medical disorders table & 1'. *iabetic eye disease 16. RESPIRATORY 11.1 +!linical features of ,!:P* 11. +!linical features of, T3 11." +!linical features of, cystic fibrosis 17. RHEUMATOLOGY 12.1 +!linical features of, 7heumatoid arthririts 12. /nti;rheumatoid drugs 12." +!linical features of, 7aynauds phenomenon

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 dilated, b. 7espiratory causes i. PE ii. Pneumonia c. :thers i. 0ypertension ii. 0yperthyroidism iii. /lcohol +and other drugs, iv. $diopathic +<lone= /F, . Treatment a. 7ate control is appropriate for most patients b. Patients 9ith structurally normal hearts may be candidates for rhythm control c. !ardioversion +rhythm control, i. >&4 hrs after onset or after 1 9ee-s anticoagulation ii. *! cardioversion iii. Flecainide iv. #otalol v. /miodarone d. 7ate !ontrol i. *igo)in ;doesnt control rate effectively alone in active patients ii. 8erapamil iii. 3eta bloc-ers e. Prophyla)is for paro)ysmal /F i. #otalol ii. Flecainide iii. /miodarone f. /nticoagulation +ris- of stro-e ";fold,

1.2 C'%#%-&' ("&$)*"! +( ."&*$ (&%')*"

1. #ymptoms a. 58F i. #:3 ii. !ough +dry or pin- frothy sputum, iii. :rthopnoea and P.* iv. !ardiac 9hee%e b. 78F i. Peripheral oedema

ii. /scites . #igns a. 3iventricular failure i. 0ypotension ii. Tachycardia iii. ?allop rhythm iv. *isplaced ape) +dilated heart, b. 58F i. 3ilateral crepitations ii. Pleural effusions c. 78F i. Peripheral oedema ii. 7aised @8P +may have giant 8 9aves if T7, iii. 0epatomegaly iv. /scites d. !A7 changes in 58F i. Bpper lobe diversion ii. !ardiomegaly iii. /lveolar oedema iv. Cerley 3 lines v. Pleural effusions 1.3 C'%#%-&' ("&$)*"! +( /%$*&' S$"#+!%! 1. !auses a. 7heumatic fever b. !ongenital c. !arcinoid syndrome d. #5E . #ymptoms a. 3reathlessness b. 0aemoptysis c. Palpitations d. 7ecurrent chest infections e. /cute pulmonary oedema ". !linical signs a. Malar flush b. /F c. Tapping undisplaced ape) d. :pening snap +mobile valve, e. Mid diastolic murmur f. Evidence of pulmonary hypertension +T7, 78 heave, 78F, &. Treatments a. Treat /F +rate control and anticoagulation, b. Endocarditis prophyla)is c. Treat heart failure d. 8alvuloplasty e. :penDclosed valvulotomy f. M87

2. CLINICAL PHARMACOLOGY 2.1 I/0+*$&#$ '%1"* "#23/" %#4)-"*! +( -3$+-.*+/" P5450 P! 37/## 1. Phenytoin 2. Carbama%epine 3. arbiturates 4. Rifampicin 5. Alcohol +chronic, 6. Sulphonylureas 7. Smo-ing 2.2 E6&/0'"! +( -'%#%-&''3 %/0+*$&#$ 4*)7 *"&-$%+#! D*)7 D*)7 E(("-$ /%athioprine /llopurinol Aanthine o)idase inhibition leads to a%athioprine to)icity /lcohol Metronida%ole Flushing, hypotension !hlorpropamide M/:$s Tyramine /cute hypertensive crisis <cheese reaction= /lpha;agonists /mphetamines /!E inhibitors #pironolactone 0yper-alaemia /miloride *igo)in 3eta;bloc-ers 5ithium /denosine #tatins /minoglycosides .#/$*s Thia%ides 5oop diuretics 8erapamil Thia%ides *ipyridamole Fibrates 5oop diuretics 7educed effect of /!E$ *igo)in to)icity by protein bindingDrenal e)cretion 0ypotension and asystole 5ithium to)icity +e)cretion, Prolonged half life of adenosine leading to asystole $ncreased incidence of myopathy and rhabdomyolysis $ncreased nephroto)icity and ototo)icity

2.3 D*)7 /"$&,+'%!/ %# $." "'4"*'3

1. ?astric p0, gastric emptying, 3lood flo9; affects absorption of drugs 2. /bsorption from i.m. inEections slo9er due to muscle mass and blood flo9 to
". &. '. 1.

muscles 7educed hepatic e)traction and metabolism 0alf life of some drugs prolonged +e.g. ben%odia%epines, ?reater volume of fat leads to increased volume of distribution for lipid soluble drugs ?F7 reduced in the elderly leading to accumulation of renally e)creted drugs +lithium, digo)in etc, 2. !hanges in homeostatic responses ma-e the elderly more susceptible to side effect of some drugs eg postural hypotension

4. Polypharmacy leads to more interactions 3. DERMATOLOGY 3.1 C&)!"! +( .30"*0%7/"#$&$%+# 1. Metabolic a. 7enal failure b. !irrhosis c. 0aemochromatosis . *rugs eg /miodarone ". Endocrine a. /ddisons disease b. !ushings syndrome c. .elsons syndrome +hyperpigmentation post;bilateral adrenalectomy, d. Pregnancy &. .utritional +Pellegra, '. 5ymphoma 3.2 N&%' -.&#7"! %# ."&'$. &#4 4%!"&!" N&%' -.&#7" Pitting and ridges :nycholysis C&)!"! Psoriasis Psoriasis :nychomycosis +fungal nail infection, Thyroid disease Trauma /cute illness +3eaus lines, Psoriasis 0ypoalbuminaemia !irrhosis Gello9 nail syndrome $ron deficiency anaemia Trauma +commonest cause, 3acterial endocarditis !onnective tissue disorders !onnective tissue disorders

?rooves 5euconychia and Fhite bands Gello9 nails Coilonychia #plinter haemorrhages .ailfold telangiectasia

4. ENDOCRINOLOGY 4.1 C'%#%-&' ("&$)*"! +( $.3*+%4 4%!"&!" H30"*$.3*+%4%!/ C+#!$%$)$%+#&' Feight loss ("&$)*"! 0eat intolerance /n)iety !lubbing CVS Tachycardia /F H30+$.3*+%4%!/ Feight gain !old intolerance 5ethargy 0oarse voice 3radycardia Pericardial effusion

S8%# M"#!$*)&' GI CNS

!ardiac failure 0air loss #9eating Pretibial my)oedema +?raves, /menorrhoea *iarrhoea Tremor Pro)imal myopathy Psychosis T" T& T#0 Microcytic anaemia 3eta 3loc-ers !arbima%ole 7adioactive $odine #urgery

Bloods

T*"&$/"#$

!ardiac failure 0air loss *ry s-in Puffy face Menorrhagia !onstipation #lo9 rela)ing refle)es *epression Poor memory !arpal tunnel syndrome T" T& T#0 Macrocytic anaemia Thyro)ine

4.2 C'%#%-&' ("&$)*"! +( A-*+/"7&'3 9H30"*!"-*"$%+# +( GH: 1. 6'H due to pituitary tumour . *iagnosis a. Failure of ?0 to suppress to oral glucose load may get parado)ical rise. b. 7aised serum $?F;1 levels c. 8isual fields d. M7$ pituitary ". Features a. E)amination i. !oarse facial appearance ii. 5arge hands D feet D hat si%e iii. Enlarged lo9er Ea9 iv. !arpal tunnel syndrome v. 0yperhydrosis vi. /rthropathy b. Metabolic i. 0ypertension ii. *iabetes mellitus c. !ardiorespiratory i. $ncreased cardiovascular mortality ii. :bstructive sleep apnoea iii. 580 and cardiomyopathy d. :thers i. 7enal stones ii. $ncreased ris- of colon cancer &. Treatment a. Pituitary surgery b. :ctreotide +somatostatin analogue, c. Pituitary irradiation d. 3romocriptine.

4.3 C'%#%-&' ("&$)*"! +( .30+&4*"#&'%!/ 1. Failure of adrenal corte) to produce normal glucocorticoids and mineralcorticoids . !auses a. /utoimmune /ddisons. +2'H, b. T3 + (H, c. Metastasis d. 0aemorrhage +Friedrichsen;Faterhouse secondary to meningococcus, e. !ongenital adrenal hyperplasia f. Pituitary failure g. Fithdra9al of long term steroids ". Features a. Fea-ness b. Pigmentation c. Feight loss d. /bdo pain e. 0ypotension &. $nvestigation a. 0ypoglycaemia b. 0yponatraemia c. 0yper-alaemia d. 0ypercalcaemia e. .ormocytic anaemia 9ith lymphocytosis f. $mpaired response to short synacthen test g. /drenal corte) antibodies in autoimmune '. Treatment a. 7eplacement hydrocortisone +dose in intercurrent infection, b. Fludrocortisone +to rplace mineralicorticoids, 5. GASTROENTEROLOGY 5.1 E!!"#$%&' ("&$)*"! +( C+"'%&- 4%!"&!" 1. #ensitivity to gluten +gliaden fraction, leads inflammatory inEury to the small intestine and subseIuent malabsorption 2. (.' H of population +recent diagnosis due to serology, ". 05/ *J in 6'H &. $nappropriate T cell response against ingested gluten 9ith the en%yme tissue transglutamase the target of autoimmune response 5. !linical features a. *iarrhoea b. /naemia +$ron, folate, 31 , c. Feight loss d. #teatorrhoea +vitamin /*EC deficiency, e. ?ro9th retardation f. :ral aphthous ulcers g. I#-*"&!"4 incidence of all ?$ malignancy +esp small bo9el lymphoma, h. R"4)-"4 incidence of breast and lung cancer

*ermatitis herpetiformis 0yposplenism k. !aD:steomalaciaDosteoporosis l. $g/ deficiency +'H, 1. *iagnosis a. *uodenalDEeEunal biopsy; intraepithelial lymphocytes, villous atrophy b. Tissue transgluaminase +tT? /bs, most accurate c. Endomysial /b 2. Treatment a. ?luten free diet ; " month recovery of villous atrophy b. Treat deficiencies c. #creen for and treat osteoporosis 5.2 F"&$)*"! +( C*+.#;! 4%!"&!" &#4 )'-"*&$%1" -+'%$%! C*+.#;! 4%!"&!" U'-"*&$%1" -+'%$%! 1. /ffects any part of the ?$ tract from mouth to anus. . !ommonly terminal ileum, colon, anorectum. ". <#-ip lesions= of normal mucosa bet9een affected areas P&$.+'+73 1. Transmural inflammation . .on;caseating granuloma +1'H, ". Fissuring ulcers &. 5ymphoid aggregates '. .eutrophil infiltrates C'%#%-&' 1. /bdominal pain prominent and freIuent fever . *iarrhoea KD; blood P7 ". Feight 5oss &. /nalDperianalDoral lesions '. Fistulae 1. #tricturing common, resulting in obstructive symptoms 2. /naemia +Fe, 31 or folate deficiency, A!!+-%&$%+#! 1. $ncidence in smo-ers +'(;1(H smo-ers, . Erythema nodosum+';1(H, ". Pyoderma gangrenosum +(.'H, &. $ritisDuveitis +";1(H, '. @oint painDarthritis +1;1 H, 1. !lubbing D%&7#+!%! 1. /l9ays involves rectum and e)tends confluently into the colon. . Terminal ileum may be affected by <bac-9ash ileitis= ". 7emainder unaffected. 1. . ". &. '. Mucosa and submucosa only involved Mucosal ulcers $nflammatory cell infiltrate !rypt abscesses 5oss of goblet cells

i. E.

1. *iarrhoea, often 9ith blood and mucus . Brgency and tenesmus ". Feight loss &. Fever '. /bdominal pain less prominent

1. $ncidence in smo-ers +2(;4(H non;

smo-ers, 2. $ncidence of primary sclerosing cholangitis ". :ther systemic manifestations less common than in !rohns disease

1. !olonoscopy and biopsy 1. !olonoscopy and biopsy . 3arium studiesL . 3arium studiesL a. !obblestoning of mucosa a. Pseudopolyps b. 7ose thorn ulcers b. 5oss of haustral pattern c. #-ip lesions c. Featureless shortened colon ". $sotope leucocyte scans useful to diagnose active small bo9el disease C+/0'%-&$%+#! 1. FistulaeL 1. Fistula do not develop a. entero;enteral . To)ic megacolon +urgent indication for b. entero;vesical colectomy, c. entero;vaginal 3. $ncreased incidence of carcinoma; ( d. perianal after (years of disease . !arcinoma ; slightly increased &. Preventative colectomy of value incidence of colonic malignancy '. $ron deficiency anaemia ". /bscess formation T*"&$/"#$ 55ASA -+/0+)#4!< +eg mesala%ine, :ral and topical treatment for flares of disease and prevention of relapses S$"*+%4!< Topical, oral or parenteral for treatment of flare up +not maintenance, A2&$.%+0*%#"< prevention of relapse TNF &'0.& &#$&7+#%!$! 9%#('%6%/&,:< Bsed in severe $3* and !rohns fistulae A#$%,%+$%-!< Metronida%ole effective particularly for perianal !rohns disease S)*7"*3< o 7ecurrence occurs in "(;1(H of patients after surgery in !rohns disease. o #urgery in B! +panproctocolectomy, may be curative. N)$*%$%+#&' !)00+*$ 5.3 E!!"#$%&' ("&$)*"! +( 1%*&' ."0&$%$%! S0*"&4 V%*)! C'%#%-&' / Faecal;oral 7./ @aundice /nore)ia .ausea Fever /rthralgia 3 3lood, *./ /symptomatic se)ual, @aundice vertical. Fever .ausea /nore)ia ?lomerulonephr itis/rthropathy ! 3lood, se)ual 7./ /symptomatic @aundice Malaise T*"&$/"#$ #upportive 3enign condition. Fulminant hepatitis in (. H #upportive. >1H fulminant hepatitis. !hronic active 038 responds to $nterferon, 5amivudine, /defovir, Entecavir #upportive for acute 0!8 +interferon may have a role, C.*+#%-%$3 .o

1(H of acute 038 becomes chronic. 6(H of vertically transmitted 038 becomes chronic. !hronic 038 patients are at high ris- of cirrhosis and 0!! 1(;4(H of those infected have persisting infection

* 3lood. $ncom *ependant plete on concurrent 038 infection for replication , E Faecal;oral 7./

E)acerbates 038 infection and increases ris- of hepatic failure and cirrhosis

Fulminant hepatitis rare. !hronic 0!8 can successfully be treated 9ith interferon and ribavirin +'(H response, $nterferon of limited benefit

+chronic 0!8, +"(H ris- of cirrhosis after "( years of infection. 0igh ris- of 0!!.

$ncreases incidence of cirrhosis in chronic 038

/symptomatic @aundice Malaise .ausea

#upportive /cute self limiting illness $n pregnancy mortality +fetal and maternal, of ' H

.o

6. GENETICS 6.1 C'%#%-&' ("&$)*"! +( M&*(&#;! !3#4*+/" 1. Mutation of fibrillin +constituent of connective tissue, !hromosome 1' . Features a. Tall stature +armspan M height, b. /rachnodactyly +long fingers, c. 0igh arched palate d. #coliosis e. 0ypere)tensile Eoints f. Bp9ard lens dislocation g. /ortic root dilatation +/7, aortic dissection, h. Mitral valve prolapse and M7 6.2 C+#4%$%+#! %#."*%$"4 %# &# A)$+!+/&' 4+/%#&#$ /&##"* 1. /dult polycystic -idney disease . ?ilberts syndrome ". 0untingtons chorea &. 0ereditary spherocytosis '. Marfans syndrome 1. Myotonic dystrophy 2. .eurofibromatosis 4. .oonans syndrome

6. :steogenesis imperfecta 1(. Familial Polyposis coli 11. Tuberous sclerosis 1 . 8on Fillebrands disease. 7. GENERAL SURGERY 2.1 !linical features of breast cancer 1. /denocarcinoma a. *uctal carcinoma 6(H b. 5obular carcinoma 1(H . Most common cancer in 9omen ". 1H of breast cancer occurs in males &. 7is- factors a. /dvanced age b. Family history +particularly mother and sister, c. .orth /merica or northern European descent d. 0igh postmenopausal blood oestrogen level e. 0igh socioeconomic status f. /ge at first full;term pregnancy older than "( years g. 0istory of cancer in the other breast h. /ny first;degree relative 9ith a history of breast cancer i. .ulliparity E. 0istory of endometrial or ovarian cancer '. ?enetics a. 37!/1 and mutations confer increased ris- of breast cancer b. "H of the breast cancer population have 37!/ 1 +2(H of 9omen 9ith early;onset breast cancer, c. 2( H of subEects 9ith 37!/1 develop breast cancer in their life time d. 37!/ lifetime ris- is ';"(H 6. Presentation a. May be asymptomatic and diagnosed by screening mammography b. Painless palpable breast lump i. !linical characteristics of malignant breast lumps 1. $rregular hard lump . Bsually painless ". :ften fi)ed to the s-in or chest 9all &. #-in dimpling '. .ipple retraction 1. 3loody discharge ii. !haracteristics of 3enign lumps +4(H of breast lumps, 1. Firm regular rubbery mass . :ften painful c. .ipple discharge d. Pagets disease of the nipple e. Peau dorange 2. *iagnosis

a. Mammography b. Bltrasound c. Fine needle aspiration d. !ore biopsy e. :pen biopsy f. !T and bone scan to loo- for metastases 4. Treatment +dependant on stage, comple) and constantly being optimised, a. 5umpectomy b. Mastectomy c. Mastectomy and a)illary clearance d. 7adiotherapy e. /dEuvent chemotherapy +constantly evolving, f. 0ormonal therapy +for oestrogen receptor positive disease, i. Tamo)ifen ii. /nasta%ole 7.2 C&)!"! +( $"!$%-)'&* ')/0! 1. Painless a. 0ydrocoele b. 8aricocoele c. #permatocoele d. Epididymal cyst e. Testicular cancer +sometimes, i. #eminomas ii. Teratoma iii. Mi)ed seminoma;teratoma iv. 5ymphoma v. Gol- sac tumours . Painful a. Epididymo;orchitis b. Torsion c. #ome testicular cancers d. 0ernias 7.3 C'%#%-&' ("&$)*"! +( 7*+%# ."*#%&! 1. $ndirect inguinal +1(H, a. 0erniation that e)tends do9n the inguinal canal and may enter the scrotum b. Failure of the obliteration of the processus vaginalis c. Medial and above the pubic tubercle d. Bsually has a cough impulse . *irect inguinal + 'H, a. Fea-ness in the abdominal 9all due to increased abdominal pressure b. 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 9omen b. Passes do9n the femoral canal c. 5ateral to the pubis tubercle d. !ommonly becomes incarcerated leading to small bo9el obstruction

&. !omplications of hernias a. $ncarceration b. $ntestinal obstruction c. #trangulation 8. HAEMATOLOGY 8.1 E!!"#$%&' ("&$)*"! +( %*+# 4"(%-%"#-3 &#&"/%& 9IDA: 1. $nvestigation findings a. 0ypochromic microcytic cells b. Pencil cells on blood film c. 5o9 ferritin d. 5o9 iron 9ith normalD high T$3! . !auses a. !hronic blood loss i. Bterine ii. ?$T 1. Peptic ulcer, . ?$ malignancy, ". !olitisD!rohns &. 0oo-9orm infection +9orld9ide most common cause, '. /ngiodysplasia 1. 0aemorrhoids b. $ncreased demands i. Prematurity ii. ?ro9th iii. !hild bearing c. Malabsorption i. ?astrectomy ii. !oeliac disease iii. Pro)imal small bo9el disease d. .utritional deficiency 8.2 L&,+*&$+*3 (%#4%#7! %# -+&7)'&$%+# 4%!+*4"*! D%!"&!" PT 8itamin C deficiency +and 9arfarin, 0eparin 5iver disease 0aemophilia Platelet defect 8on;Fillibrands disease *$! . . . APTT . TT . . or . . . T . . .or . PL . . . or . . + in $TP, .

8.3 C'%#%-&' ("&$)*"! +( !%-8'" -"'' 4%!"&!" 1. *ue to production of abnormal beta chain in haemoglobin . 8aline replaces glutamic acid in position 1 of the beta chain to form 0b#

". &. '. 1.

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 trait a. Mild often asymptomatic. May get sic-ling under ano)ic conditions 2. 0omo%ygotes 0b## N #ic-le cell disease a. !hronic haemolytic anaemia b. 7ecurrent crises 4. #ic-le cell crisis precipitated by a. 0ypo)ia b. $nfection c. *ehydration d. #ystemic illness 6. Features of crisis a. Pain due to bone marro9 infarction b. #ic-le dactylitis infarction of small bones of hands and feet c. #plenic infarction leads to hyposplenism d. Thrombotic stro-e e. 7etinopathy f. Pulmonary infarction;chest syndrome g. Priaprism painful sustained erection 1(. :ther features a. /plastic crisis usually precipitated by parvovirus 316 infection b. /vascular necrosis of nec- of femur c. 5eg ulcers d. ?allstones +pigmented due to haemolysis, 11. *iagnosis a. 0aemoglobin elecropheresis b. 3lood film anaemia, sic-le cells, increased reticulocyte count, target cells c. Positive sic-ling test 9. HIV 9.1 R"!0%*&$+*3 -+/0'%-&$%+#! +( HIV 1. 8iral infections a. /denovirus b. $nfluen%a c. !M8 . 3acterial a. Streptococcus pneumoniae b. Staphylococus aureus c. Tuberculosis i. !ommon presentation ii. E)tra pulmonary disease common iii. *oes not tend to have classical !A7 iv. Multi;drug resistance is more common v. /typical mycobacterium infections occur e.g M. avium complex vi. !an occur 9ith any !*& count

". Pneumocystis carinii pneumonia a. !ommon presentation b. Bsually occurs 9hen !*& > (( c. /bnormal !A7 in 6(H d. 0ypo)ic e. *ry cough, fever, malaise f. Treatment is 9ith high dose co;trimo)a%ole &. Fungal a. !andida b. Histoplasmosis c. !ryptococcus 10. IMMUNOLOGY 10.1 A)$+&#$%,+4%"! &#4 4%!"&!" D%!"&!" 0ashimotos thyroiditis ?raves disease Pernicous anaemia /ddisons disease $**M Myasthenia gravis 5ambert Eaton syndrome ?ullain;3arre syndrome ?oodpastures syndrome /$ haemolytic anaemia $TP P3! #ome male infertility A#$%7"# Thyroglobulin Thyroid pero)idase T#0 receptor $ntrinsic factor Parietal cell /drenal corte) cells !ytoplasm of islet cell $nsulin ?lutamic acid decarbo)ylase +?/*, /cetyl !holine receptor !a channels on nerve endings Peripheral nerve myelin components ?lomerular and lung basement membrane Erythrocytes Platelets Mitochondria #permato%oa

10.2 E!!"#$%&' ("&$)*"! +( CRP Bseful in monitoring inflammation /cute phase reactant produced mainly in the liver 7ises 9ithin hours Falls in ;" days Mar-ed elevation 3acterial infection /bscess !rohns disease !onnective tissue diseases +e)cept #5E, .eoplasia Trauma .ecrosis

.ormal or slight elevation 8iral infection #teroidsDoestrogens B! #5E 11. INFECTIOUS DISEASE 11.1 C'%#%-&' ("&$)*"! +( /&'&*%& !aused by the proto%oan plasmodium sp #pread by bite of female anopheles mosIuito & types 3enign 8iva) :vale Malariae Malignant Falciparum !linical features Fever 9ith drenching s9eats 7igors 0eadache Myalgia * and 8 3enign 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 mortality, 0aemolytic anaemia Metabolic acidosis 0ypoglycaemia /cute renal failure Pulmonary oedema 0igh parasite count N more severe disease Treatment :ral or $.8. Juinine /lternatives include Malarone, MefloIuine *iagnosis #erial thic- and thin films 7apid antigen tests :ther results /naemia Thrombocytopenia 0ypoglycaemia /bnormal coagulation

Remember always to consider malaria in patient who has travelled to malariaous area even if they have taken prohpylaxis 11.2 E!!"#$%&' ("&$)*"! +( L3/" 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, malaise ii. /rthralgia +Eoint pain, iii. Myalgia +muscle pain, iv. 0eadaches v. Erythema migrans target lesion sat site of tic- bite b. Early disseminated disease i. :ccurs 9ee-s to months after initial infection ii. .eurological disease +especially meningitis and 3ellOs palsy, iii. Myocarditis iv. /rthropathy 9ithout Eoint effusion c. 5ate disseminated disease +previously called #tage ", i. :ccurs months to years after initial infection ii. Typified by chronic arthritis andDor encephalopathy +sleep disturbances, fatigue, personality changes,. 12. META OLIC 12.1 E!!"#$%&' ("&$)*"! +( .30+-&'-&"/%& 1. !auses a. 0ypoparathyroidism b. !hronic renal failure c. 5o9 levels of vitamin *" d. 0yperphosphataemia e. 0ypomagnesaemia f. #epsis g. 7espiratory al-alosis h. !alcium deposition + eg acute pancreatitis, i. !arcinoma of prostate . Features a. Muscle 9ea-ness b. .euromuscular e)citability c. !onfusion d. #ei%ures e. Tetany f. !ataracts g. *ental hypoplasia ". Treatment

a. #upplementation of calcium, vitamin *"

12.2 I#$"*0*"$&$%+# +( *"!)'$! %# 0&$%"#$! =%$. ,+#" 4%!"&!" *isease !a P:& /5P 0yperparathyroidism or . or . +primary, 0ypoparathyroidism . :steoporosis . . . :steomalacia Pagets . . 7enal failure or . 12.3 E!!"#$%&' ("&$)*"! +( .30"*8&'&"/%& 1. !auses a. #puriousP i. 0aemolysis ii. E)cessive inta-e +parenteral, oral, b. *ecreased e)cretion i. /cute oliguric renal failureP ii. !hronic renal failureP iii. *rugsP 1. #pironolactone . /miloride ". /!E inhibitors &. .#/$*# iv. /ddisonQs disease v. 0ypoaldosteronism c. 7edistribution i. /cidosisP ii. 7habdomyolysis iii. Tumour lysis syndrome iv. *igo)in poisoning . E!? changes a. Tenting of T 9aves b. 7eduction in si%e of P 9aves c. $ncrease in P7 interval d. Fidening J7# comple)es e. *isappearance of P 9aves f. #inusoidal 9aveform ". Treatment a. $8 calcium gluconate +stabilises cardiac membranes, b. $8 insulin and de)trose c. !alcium resonium d. Frusemide e. #albutamol nebulisers f. *ialysis PT0 . .

13. NEPHROLOGY 13.1 I#1"!$%7&$%+# +( A-)$" R"#&' F&%')*" 1. Full history and e)amination a. R #ystemic cause b. *rug history;penicillin or .#/$*# c. Family history . Bltrasound scan a. 7ule out obstruction b. Cidney si%e +if small then acute on chronic, ". Brine a. Microscopy of urine +pgR, b. !ulture and sensitivity c. Protein d. 0aematuria e. !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 1. 3lood tests a. #pecific i. /nti;?3M antibodies ?oodpastureQs disease ii. /.!/ #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 vasculitis 5o9 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 iii. !ryoglobulins iv. !7P v. Eosinophilia vi. 5ymphopenia $g/ nephropathy !ryoglobulinaemia $ncreased in most cases but not usually in #5E *rug induced interstitial nephritis !hurg;#trauss syndrome #5E

13.2 C'%#%-&' ("&$)*"! +( O!$"+43!$*+0.3 1. 3one disease that results from the metabolic disturbance in renal failure

2. Pathophysiology
i. 5o9 plasma ioni%ed calcium ii. *ue toL 1. lac- of 1, ' dihydro)yvitamin * . Malabsorption of calcium ". 0yperphosphataemia +failure of e)cretion, b. #timulation of Parathyroid hormone release +#econdary 0yperparathyroidism, i. *ue toL 1. 0ypocalcaemia . 0yperphosphataemia ". 5o9 1, ' *i; +:0, 8it * &. /cidosis ". !linical features a. :steoporosis b. :steomalacia c. /reas of osteosclerosis +rugger;Eersey spine, &. Treatment a. Phosphate binders +e.g. calcium acetate, b. 8itamin * +1;alphacalcidol, c. Parathyroidectomy 13.3 M&#&7"/"#$ +( C.*+#%- R"#&' F&%')*" 1. 3lood pressure control +aim for >1"(D2', a. /!E inhibitors b. :ther anti;hypertensives c. *iuretics . 7eduction in proteinuria a. /!E inhibitors 3. Treatment of anaemia +maintain 0bM1(, a. $8 iron b. Erythropoetin &. *iet a. 5o9 salt inta-e b. 5o9 Potassium inta-e c. 0igh !alorie inta-e 5. Treatment of hyperphosphatemia and hypocalcaemia +renal bone disease, a. Phosphate 3inders b. /lphacalcidol 1. ?lucose control in *iabetics 2. !ontol hyperlipidaemia 4. 8olume #tatus monitoring 6. /void nephroto)ic *rugs 14. NEUROLOGY 14.1 C'%#%-&' ("&$)*"! +( $.%*4 #"*1" 0&'!3 1. "rd nerve supplies all the e)traoccular muscles e)cept superior obliIue and lateral rectus

. !arries parasympathetic pupiloconstrictor fibres ". .ucleus in pons &. Features a. *ilated unreactive pupil b. Ptosis c. $nability to move the eye superiorly, inferiorly, medially d. Eye do9n and out at rest '. !auses a. 8ascularD*iabetesDdemyelinationDtraumaP b. Posterior communicating artery aneurysmP c. !avernous sinus thrombosis, d. :rbital tumour e. Thyroid eye disease f. Trauma 14.2 C'%#%-&' ("&$)*"! +( !),&*&-.#+%4 .&"/+**.&7" 9SAH: 1. !auses a. 7upture of aneurysm 4(H anterior circulation +mainly ant. communicating artery, b. 0ypertension c. /rterio;venous malformation d. Trauma e. !ocaine or amphetamine abuse . #ymptoms a. 0eadache +sudden onset and severe, b. 8omiting c. !oma. ". *iagnosis a. !T scan +6(H diagnostic yield, b. 5umbar punctureL i. )anthochromia +T& hours post episode, clears after 9ee-s, ii. U blood cell count on microscopy +unreliable as (H taps are traumatic, c. !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. 1. !onditions associated 9ith #/0 a. Polycystic -idney disease b. Ehlers*anlos syndrome c. Marfans syndrome d. .eurofibromatosis type 1 14.3 C'%#%-&' ("&$)*"! +( -&*0&' $)##"' !3#4*+/" 1. Median nerve palsy +nerve compressed at 9rist,

. Features a. Pain and parasthesia +9orse at night, b. Parasthesia of lateral "V fingers c. Fea-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 tingling c. .erve conduction studies '. Treatment a. #plinting of 9rist b. #teroid inEection to fle)or retinaculum c. #urgical decompression. 15. OPHTHALMOLOGY 1'.1 Eye signs in medical disorders S%7# 3itot spots 3lue sclera D%!+*4"* 8itamin / deficiency :steogenesis imperfecta Pseudo)anthoma elasticum Ehlers;*anlos syndrome Marfans syndrome 0yperthyroidism *o9ns syndrome 0ypercholesterolaemia +type a and b, :ld age #arcoidosis 0yperparathyroidism !hronic renal failure 8itamin * abuse Filsons disease .eurofibromatosis #ubacute bacterial endocarditis 5eu-aemia *iabetes

3rushfield spots !orneal arcus !orneal calcification

Cayser;Fleischer rings 5isch nodules 7oth spots

15.2 D%&,"$%- E3" 4%!"&!" 9/+!$ -+//+# -&)!" +( ,'%#4#"!! %# 0&$%"#$! &7"4 30560: 1. 3ac-ground retinopathy a. 8isual acuity unaffected b. Microaneurysms c. 0aemorrhages d. 0ard e)udates . Pre;proliferative retinopathy a. !otton 9ool spots b. *ilatation and beading of retinal veins c. $ntraretinal microvascular abnormalities 3. Proliferative retinopathy +more common in type 1 diabetics, a. .eovascularisation b. Treated cases 9ill have panretinal laser burns &. /dvanced diabetic eye disease a. 8itreous haemorrhage b. Tractional retinal detachment c. 7ubeotic glaucoma 5. Maculopathy +more common in type diabetics, a. :edema and e)udates b. Macular #tars +multiple e)udates, c. 5oss of central vision +peripheral spared, 1. Treatment a. ?ood diabetic control b. Treat hypertension c. #top smo-ing d. Treat hypercholesterolaemia e. 7egular fundal e)amination f. Focal retinal photocoagulation g. Panretinal photocoagulation 16. RESPIRATORY 16.1 C'%#%-&' ("&$)*"! +( C.*+#%- O,!$*)-$%1" P)'/+#&*3 D%!"&!" 9COPD: 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 can be seen on !T, 1. Mar-ed morbidity D mortality 2. !linical featuresL a. cough +usually productive, b. #:3 c. Fhee%e d. 7ecurrent e)acerbations

P%#8 0)(("* 0yperventilation !: +type 1 resp failure, 3reathless but not cyanosed

')" '+&$"* 0ypoventilation !: +type resp failure, !yanosed but not breathless !or pulmonale

8. FE81 D F8! ratio > 2'HW FE81 > 4(H of predicted

6. Treatments 1(. /cute as for asthma but o)ygen therapy must be controlled as some patients have type respiratory failure 11. !hronic a. #topping smo-ing +:nly measure that 9ill slo9 progression, b. $nfluen%a and pneumococcal vaccine c. Mild disease +FE81 1(;4(H, i. #hort acting 3eta agonist or ipratropium as reIuired d. Moderate +FE81 &(;'6H, i. 7egular #hort acting 3eta agonist or ipratropium ii. !onsider corticosteroid trial, if reversibility +M1' H improvement in FE81 then give steroid inhaler e. #evere + FE81 >&(H, i. .ebuliser trial ii. !onsider long term o)ygen therapy 1 . !omplications a. 7espiratory failure b. 7ecurrent <E)acerbations= c. !or pulmonale d. Polycythaemia e. Pneumothora) f. 5ung cancer +smo-ing, g. :steoporosis +steroids, 16.2 C'%#%-&' ("&$)*"! +( $),"*-)'+!%! 1. /t;ris- groups a. $mmigrants from endemic areas b. /lcoholics c. 0$8;positive d. 0omeless and lo9 income . Primary T3 a. May be entirely asymptomatic b. $nfection in person 9ith no immunity c. ?hon focus develops in lung d. 3acilli transported through lymphatics e. $nfection arrested f. Tuberculin tests becomes positive after this g. May cause mild cough, 9hee%e and erythema nodosum ". Post;primary T3 a. 7eactivation of disseminated dormant organisms &. Miliary T3

a. Fidespread haematological spread of bacilli '. #ymptoms a. .ight s9eats b. Feight loss c. !ough d. 0aemoptysis e. Pleural effusion f. Meningitis 1. *iagnosis a. !A7 +upper lobe shado9ing, loss of volume, cavitation, b. #putum e)amination for acid;alcohol fast bacilli +//F3s, c. Early morning urine for //F3s d. 5ymph node biopsy e. 3one marro9 aspirate f. 3ronchoscopy and lavage g. !ulture ta-es at least 1 9ee-s 2. Treatment a. Triple therapy 9ith rifampicin, isonia%id and pyra%inamide b. /dd ethambutol for those 9ith 0$8 or from area associated 9ith resistance c. Triple D Iuadruple therapy for months, rifampicin D isonia%id further & months d. !ompliance very important e. #ide effects common i. 7ifampicin 1. 0epatitis . .ausea ". Pin- D orange urine &. En%yme inducer ii. $sonia%id 1. 0epatitis . Peripheral neuropathy +cover 9ith pyrido)ine, iii. Pyra%inamide 1. 0epatitis . 7ash ". ?out iv. Ethambutol 1. :ptic neuritis . 7enal dysfunction 16.3 C'%#%-&' ("&$)*"! +( -3!$%- (%,*+!%! 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 +14H of cases, 1. *efect of chloride and 9ater transport across epithelial cell membrane 2. *iagnosis by s9eat testW sodium and chloride concentrations M 1( mmol D l 4. 5ife e)pectancy improving +M &(yrs,. 6. 7espiratory features

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.and

urkholderia cepacia c. Treat 9ith antibiotics, acutely and prophylactically 1(. ?astrointestinal features a. Pancreatic insufficiency in 4(H b. Meconium ileus in infancy, small bo9el obstruction in adults c. !hronic liver disease seen due to biliary obstruction d. ?allstones e. Pancreatitis 11. :ther features a. *iabetes +M "(H of patients in late teens, b. Pneumothora) +'H, c. $nfertility +almost all men, d. :steoporosis 17. RHEUMATOLOGY 17.1 C'%#%-&' ("&$)*"! +( *.")/&$+%4 &*$.*%$%! 1. This is an autoimmune chronic inflammatory polyarthropathy . 7evised /merican !ollege of 7heumatology criteria for the classification of rheumatoid arthritis +1642, +7/ if at least & of the 2 criteria, a. Morning stiffness +M1hr, for M 1 9-s b. /rthritis of MN" Eoint areas for M 1 9-s c. /rthritis of the hand Eoints for M 1 9-s d. #ymmetrical arthritis e. 7heumatoid nodules f. #erum rheumatoid factor g. 7adiographic changes ". @oint involvement in 7/ a. #ymmetrical polyarthropathy affectingL i. M!P 6(H ii. P$P 6(H iii. MTP 6(H iv. Frists 4(H v. Cnees 4(H vi. /n-leDsubtalar 4(H vii. #houlder 1(H viii.0ip '(H ix. Elbo9 '(H x. !ervical spine &(H &. Features of rheumatoid hands a. #ymmetrical deforming polyarthropathy affecting M!P, P$P and 9rist Eoints b. #pares *$P c. /ctive Eoints are hot, s9ollen and tender. d. Blnar deviation at M!P

e. #ublu)ation at M!P and 9rist f. #9an nec- deformity g. 3utonniere deformity h. X deformity of thumbs i. Fasting of dorsal interossei E. /bsence of psoriatic nail changes -. .ail fold infarcts or vasculitic lesions l. Evidence of carpal tunnel syndrome m. Palmer erythema '. E)tra;articular features of 7/ a. .on;organ specific i. Feight loss ii. Fever iii. 5ymphadenopathy iv. 7heumatoid nodules +patients 9ill be rheumatoid factor Kve, v. Feltys syndrome vi. /myloidosis vii. $ncreased susceptibility to infections viii.:steoporosis b. :rgan #pecific i. !ardiac 1. Pericarditis and effusion . 8alvular heart disease ii. Pulmonary 1. Pleurisy . Pleural effusion ". $nterstitial fibrosis &. .odular lung disease '. 3ronchiectasis 1. !aplans syndrome +nodules and progressive massive fibrosis in coal 9or-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 ". #Eogrens #yndrome 1. 5aboratory findings in 7/ a. /naemia; normochromic or hypochromic, normocytic b. Thrombocytosis c. 7aised E#7 d. 7aised !7P e. 7aised ferritin f. 5o9 iron concentration

5o9 total iron binding capacity 7aised globulins 7aised /5P 7heumatoid factor i. /utoantibodies against the Fc component of $g? antibodies ii. Kve in 4(H of 7/ patients iii. Found in 'H of the general population +up to 'H in M2'yr olds, 2. 7adiological features in 7/ a. #oft tissue s9elling b. 5oss of Eoint space due to erosion of articular cartilage c. @u)ta;articular osteoporosis d. Marginal bone erosions e. @oint deformities 4. *rug treatments for 7/ a. #ymptom modifying drugs i. /nalgesics ii. .#/$*s b. *isease modifying drugs i. /ntimalarials ii. #ulphasala%ine iii. ?old iv. Penicillamine v. !orticosteroids vi. Methotre)ate vii. /%athioprine viii.!yclosporin i). $nfli)imab 12. /nti;rheumatoid drugs 1. 0ydro)ychloroIuine a. $mpairs complement;dependent antigen;antibody reactions b. #ide effects i. Pigmentation ii. Maculopathy iii. 5eucopenia . ?old a. $nhibits macrophage activity b. #ide effects i. *ermatitis +"(H, ii. Proteinuria and ?lomerulonephritis iii. Thrombocytopenia iv. 5eucopenia v. /plastic anaemia ". Penicillamine a. *epresses circulating $gM rheumatoid factor and T;cell activity b. #ide effects i. Maculopapular rash ii. 5oss of taste iii. Proteinura and nephrotic syndrome

g. h. i. E.

&.

'.

1.

2.

iv. *rug induced lupus v. Myasthenia gravis vi. Thrombocytopena vii. Pancytopenia #ulpha%ala%ine a. #ulphapyridine +active molecule, decreases inflammatory reactions and systemically inhibits prostaglandin synthesis. b. #ide effects i. .ausea ii. #-in rashes iii. 0epatitis iv. Pulmonary eosinophilia v. 0aemolytic anaemia vi. Pancytopenia vii. 7educed sperm +reversible, Methotre)ate a. Folic acid antagonist cytoto)ic drug b. 3inds to dihydrofolate reductase and interferes 9ith *./ synthesis and cell replication c. #ide effects i. 0epatic fibrosis ii. 3lood dyscrasias !yclophosphamide a. Po9erful immunosupressant that reduces both antibody mediated and cell mediated response b. #ide effects i. 0aemorrhagic cystitis ii. Pancytopenia /%athioprine a. $nhibits nucleic acid synthesis, suppressing cell;mediated hypersensitivity and altering antibody production. b. #ide effects i. 3one marro9 suppression ii. !holestatic hepatitis iii. .ausea and vomiting iv. Pancreatitis

17.3 E!!"#$%&' ("&$)*"! +( R&3#&)4;! 0."#+/"#+# 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. $diopathic b. !onnective tissue disorders c. !ervical rib d. $ncreased plasma viscosity e. *rugs; 3eta bloc-ers f. 8ibrating instruments

'. Treatments a. Farmth b. .o smo-ing or 3eta bloc-ers c. !alcium channel bloc-ers d. ?T. e. Prostacyclin infusion