Ankylosing spondylitis features - the 'A's

Apical fibrosis
AnteriQr uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
AmyloidOSIS

Anorexia features

most things low

G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carot!naemia

Anti-cyclic citrullinated peptide antibodies are ass.odated with rheumatoid arthritis

Anti-retroviral therapy for HIV is now started at the time of diagnosis, rather than waiting for the CD4 count to drop
to a particular level

Anti-fibonuclear protein (anti-RNP) = mixed connective tissue disease

Antibtotic prophylaxis reduces mortalit y in cirrhotic palienls with gastrointestinal bleeding

Ant•opat•on 1n trinucleotide repeat disorders =earlier onset 1n successive generat•ons

Antldiurettc hormone (ADH) - site of action =collecting ducts

Antiphosphol1pid syndrome in pregnancy: aspirin + LMWH

Antiphosph<M1pid syndrome: (paradoxically) prolonged APTI + low platelets

Antiphospholipid syndrome: arterial/\lenous thrombosis, miscarriage, livedo reticularis

Antiplatetets

TIA: dopidogrel
ischaemic stroke; dopidogrel

Antipsychotlcs in the elderty- increased risk of stroke and VTE

Aortic dissection

type A- ascending aorta- control BP(IV labetalol) +surgery

type B- descending aorta- control BP(IV labetalol)

Aortic stenosis- 54 is a marker of severity

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 Pulmonary surfactant - main constituent is dlpalmltoyl phosphatldylchollne (DPPC)

Pulsus ahemans- seen in left \lentricular fa1lure

QT interval: Time between the start of the Q wave and the end of the T wave

Rabies- following possible exposure give immunglobulin + \laccination

Rap4dty progressi\le glomerulonephritis, causes:

Goodpasture's
ANCA positive vasculitis

Rasburi<:ase - a recombinant version of urate oxidase, an enzyme that metabolizes uric acid to allantoin

Rayna1.1d's d1seCtse (i.e. primary) presents in young women with bilateral symptoms

Recommend Adult Life Support (ALS) adrenaline doses

anaphylax•s: 0 .5ml 1: 1,000 IM

cardiac arrest: 10mi1: 10,000 IV or 1ml of 1:1000 IV

Red eye- glaucoma or uveitis?

glaucoma: severe pain, haloes, 'semi-dilated' pupil

uveitis: small. fixed oval pupil, ciliary flush

Refeeding syndrome causes hypophosphataemia

Relative nsk = EER I CER

Relative risk reduction = (EER- CER) I CER

Renal stones on x-ray

cystine stones: semi--opaque

urate +xanthine stones: rad io-lucent

Renal transplant + infection ?CMV

Renal transplant HLA matching -DR is t he most important

Renal tubular acidosis causes a normal an1on gap

Restless leg syndrome- management includes dopamine agonists such as ropinirole

1129
Restrictive cardionwooathv: amvloid (most common). haemochromatosis. Loftier's svndrome. sarcoidosis.

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 Bart1er's syndrome is associated with nOfiDOtension

Bendroflumethiazide -mechanism of hypokalaemia:

increased sod1um reaching the collecting ducts

activation of the renin-angiotensm-aldost erone

Bendroflumertnazide - site of action= prox1mal part of the- d1stal f;Onvoluted tubules

Benzodiazepines enhance the effect of GABA, the main Inhibitory neurotransmitter

BetaLblocker overdose management: atropine + glucagon

Bilateral idiopathic adrenal hyperplasia is the most common cause of primary hyperaldosteronism

Bisphosphonates can cause a variety of oesophageal problems

Bisphosphonates inhibh osteoclasis

Brtemporal hemianopia

lesion of optic chiasm

upper quadrant defect > lower quadrant defed = inferior chiasma! compression, commonty a pituitary
tumour
lower quadrant defect> upper quadrant defect= superior chiasma! compression, commonly a
aaniopharyngioma

Blisters/bullae

no m ucosal involvement (in exams at least•): bullous pemph1gold

mucosal involvement pemphigus w lgaris

Blood pressure target (based on clinic readmgs) for pabents < 80 years · 140190 mmHg

Bosentan - endothetin -1 receptor antagonist

Breakthrough dose = 1/6th of daily morphine dose

Breast feeding is acceptable With nearly all anti~pilepl ic drugs

Bronchiectasis: most common organism= Haemophilus inftuenzae

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Brush border enzymes:

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 Painful tturd nerve palsy= posterior communicating artery aneurysm

Paradoxical embolus - PFO most common cause - do TOE

Paraneoplastic features of lung cancer

squamous cell: PTHrp, clubbing, HPOA

small cell: ADH, ACTH, Lambert-Eaton syndrome

Parkinson's disease · most common psychiatric problem is depression

Paroxetine · higher incidence of discontinuation symptoms

Patent ductus arteriosus- collapsing pulse

Patients cannot drive for 6 months following a seizure

Patients on msulin may now hold a HGV licence if they meet strict DVLA criteria

Patients on long-term steroids should have their doses doubled during intercurrent illness

POiltients with Sjogren's syndrome have an increased risk of lymphoid malignanoes

Patients with established CVO should take atorvastatin 80mg on

Peulz-Jeghers syndrome - autosomal dominant

Phaeochromocytoma: do 24 hr unoary metanephrines, not catecholamines

Philadelphia translocation, 1(9;22) - good prognosis in CML, poor prognosis 1n AML +ALL

Pneumocyst•s Jlrovec~ pneumonia - pneumothorax IS a common complication

Pneumonia in an alcoholiC· t<Jebsiella

Polycystic ovarian syndrome - ovarian cysts are the most consistent feature

Polycythaemia rubra vera - JAK2 mutation

Polycythaemia n..~bra vera - around 5-15% progress to myelofibrosis or AML

Polycythaemia rubra vera IS associated with a low ESR

Polymorphic eruption of pregnancy is not associated with blistering

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 Hypertension in diabetics- ACE...jnhibitors are first-line regardless of age

Hypertension should not be treated in the mitial period following a stroke

Hypocalcaemia: Trousseau's sign is more sensitive and specific than Chvostek's sign

Hypokalaemia • U waves on ECG

lCD means loss of HGV l~eence, regard$ess of the circumstances

ITP · give oral prednisolone

lgO is involved in the activation of B-cells

lgM paraproteinaemia • ?Waldenstrom's macroglobulinaemia

Impetigo· topical fusidlc acid ........ oral Rucloxacfllln I topical retapamulin

In the pnmary prevention of CVD using statms aim for a reduction in non-HDL cholesterol of> 40%

Infective endocarditis- indications for surgery:

severe valvular inoompetence

aortic abscess (often Indicated by a lengthening PR interval)
infections resistant to antibiotics/fungal infections
cardiac failure refractory to standard medical treatment
recurrent emboli after antibiotic therapy

lnfecbve endocarditis- streptococcal infection carries a good prognosis

Infective endocarditis- strongest risk fador is previous episode of infective endocarditis

Inferior Ml- light coronary artery lesion

Infertility in PCOS- domifene is superior to metformin

Insoluble sources of fibre such as bran and wholemeal shouk:l be avoided in IBS

lnsulinoma is diagnosed with supervised prolonged fasting

Iron reduces the absorption of thyroxine

lsocyanates are the most common cause of occupational asthma

Isoniazid lnhlbfts the P450 system

lsomazid causes peripheral neuropathy

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lsotretinoin adverse effects

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 Obese T2DM with abnormal lFTs-? non-alcoholic fatty liver disease

Obese, young female with headaches I blurred vision t hink kf•op~thic intracrctnial hypertension

Obesity- NICE bariatric referral cut-offs

w•th risk facto.., (T2DM, BP etc):> 35 kgJm-'2

no risk factors: > 40 kg/m"2

Obesity hormones

Leptin Lowers appetite

Ghrelin Gains appetite

Odds- 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

Oesophageal adenocarcinoma is associated w1th GORD or Barrett's

Optic neuritis is common in patients taking ethambutol

Oral ulcers +genital ulcers +anterior uveitis= Behcet's

Osteoarthritis- paracelamol +topical NSAIDs (if knee/hand) first-line

Osteomalacia

low. calcium, phosphate

ra1sed: alkaline phosphatase

Osteomyelitis: MRI is the imaging modality of choice

Osteoporosis in a man- check testosterone

Oxygen dissociation curve

sh•fts Left· lower oxygen delivery- Lower acidity, temp, 2--3 DPG- also HbF, carboxy/methaemoglobin
shins Right- Raised oxygen delivery- Raised acidity, temp, 2-3 DPG

PCI- patients with drug--eluting stents require a lo nger duration of dopidogrel therapy

PC I: stent thrombosis- Withdrawal of antiplatelets biggest risk factor

Paget's disease - old man, bone pain, raised ALP

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 Mechanical valves - target JNR:

aortic: 3.0
mitral: 3.5

Med~eat•on overuse head~he

simple analgesia + triptans: stop abruptly

opioid analgesia: Withdraw gradually

Meglitinides- stimulate insulin release - good for erratic lifestyle

Melanoma: the: invasion depth of the tumour is the: s•ngle most important prognostic factor

Membranoproliferative glomerulonephritis (mesangiocapillary)

type t: cryoglobul•naemia, hepatitis C

type 2: partial lipodystrophy

Mesangiocapillary glomerulonephritis (membranoproliferative)

type 1: cryoglobulinaemia, hepatitis C

type 2: partial lipodystrophy

Metastatic bone pain may respond to NSAIDs, bisphosphonates or radiotherapy

Metformin should be titrated slowly, leave at least 1 week before increasing dose

Methadone •s a common cause: of QT prolongation

Methaemoglobinaemia:: oxidation of Fe2+ in haemoglobin to Fe3+

Migraine

acute: triptan + NSAJD or triptan + paracetamol

prophylaxis: topiramate or propranolol

Miller Fisher syndrome- areflexia, ataxia, ophthalmoplegia

Minimal change glomerulonephritis- prednisolone

MRochondrial diseases follow a maternal inheritance pattern

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 lsotretinoin adverse effects

teratogeniQty ·females MUST be tak1ng contraception

low mood
dry eyes and lips
raised triglycerldes
hair thinning
nose bleeds

JVP: C wave -closure of the tricuspid valve

JVP: giant v waves in tricuspid regurgitation

JVP: x descent= fall in atrial pressure during ventncular systole

JVP: y descent= opening of tricuspid valve

Kaposrs sarcoma - caused by HHV·B (human herpes virus 8)

Keams-Sayre syndrome

mitochondrial inheritance
onset < 20-years-old
external ophthalmoplegia
rebmtis pigmentosa

Keloid scars- more common in young, black, male adults

Keloid scars are most common on lhe sternum

Klinefelter's- LH & FSH raised

Kallman's -LH & FSH low-normal

Klinefelter's?- do a karyotype

l51esion features= loss of foot/big toe dorsiflexion+ sensory loss dorsum of the foot

LH surge causes ovulation

Labetalol is first-line for pregnancy-induced hypertension

lateral epicondyhtis: worse on resisted wrist extension/suppinabon whilst elbow extended

Lateral medullary syndrome- PICA lesion -cerebellar signs, contralateral sensory loss & ipsilateral Homer's

leptin is secteted by adipose tissue

Leptosp1ros1s • g1ve peniQitln or doxycycline

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 Hemiballism is caused by damage to the subthalamic nudeus

Heparin·induced lhrombocytopaenia - antibodies form against complexes of platelet factor 4 (PF4) and heparin

Hepatit1s C • 80-85% become c;:hronicalty infected

Hepatocellular carcinoma

hepatdis B most oommon c:ause worldwtde

hepatrtis C most common cause in Europe

Hepatorenal syndrome •s primanly ~us-ed by spl;:mr;;hnic vasOdilation

Hereditary angioedema · C 1-INH deficiency

Hereditary angioedema - C4 is the best screening test inbetween attacks

Hered1tary haemorrhagic telangiectas•a- autosomal dominant

Hiccups in palliative care- chlorpromazine or haloperidol

Hodgkin's lymphoma - best prognosis = lymphocyte predommant

Hodgkin's lymphoma- most common type = nodular sderos1ng

Holmes ADie = Dilated pupil, females, absent leg reflexes

Homoc::ystinuna- give vitamin B6 (pyridoxine)

Homocystinuria is caused by a defidency of cystathionine beta synthase

Homer's syndrome- anhydrosis determines site of lesion:

head, arm, trunk =central lesion: stroke, syringomyelia

just face =pre-ganglionic lesion: Panooast's, cervical rib
absent= post-ganglionic lesion: carotid artery

Hypercalcaemia, renal failure, high total protein= myeloma

Hypercholesterolaemia rather than hypertriglyceridaemia: nephrotic syndrome, cholestasis, hypothyroidism

Hypertension· NICE now recommend ambulatory blood pressure momloring to aid d1 ~gno$i $

Hypertension · step 4

K· < 4.5 then sp•ronolactone

K· > 4.5 then higher-dose thiazide-like diuretic

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 Restrictive cardiomyopathy: amyloid {most common), haemochromatosis, Loftier's syndrome, sarcoidosis,
scleroderma

Retinitis pigmentosa- night blindness +tunnel vision

Rheumatoid arthntis - HLA DR4

Rheumatoid arthritis- TNF is key in pathophysiology

Rheumatoid arthritis: patients have an increased risk of IHD

Rheumatoid factor is an lgM antibody ag~unst lgG

R ituximab · monoclonal antibody against CD20

Ropinirole - dopamine receptor agonist

SlADH- drug causes: carbamazepine. sutfonylureas. SSRis, tricyclics

SLE - antibodies assodated with congenital heart block= anti-Ro

SLE: ANA is 99% sensitive- anti-Sm & anti-dsDNA are 99% specific

SLE: C3 & C4 low

SSRI + NSA/0 = Gl bleed•ng nsk ·give a PPI

Sarcoidosis CXR

1 = BHL
=
2 BHL +infiltrates
=
3 infiltrates
4 =fibrosis

Scabk!s- permelhrin treatment all skin induding scalp+ leave for 12 hours+ retreat in 7 days

Schistosoma haematoblum causes haematuria

Sderitis is painful, epfsclentis is not painful

Screening tor haemochromatosis

general populahon: transferrin saturation> femtin

family members: HFE genetic testing

SeHCAT is the inveshgahon of choice for bile aod malabsorption

Seborrhoeic dermatitis- first~me treatment is topical ketoconazole

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 Gingival hyperplasia: phenytoin, ciclosporin, calcium channel blockers and AML

Gitelman's syndrome: normotension with hypokalaemia

Give 50% or normal energy intake in starved patients (> 5 days) to avoid refeeding syndrome

Gliplans = Oipeptidyl peptidase-4 (OPP-4) inhibitors

Glitazones are agonists of PPAR-gamma receptors, reducing peripheral insulin resistance

Gout: stcut allopurinol If>= 2 Oilttacks in 12 month period

Graves' disease 1s the most common cause of thyrotoxicosis

H IV- multiple ring enhancing lesions = toxoplasmosis

HIV drugs, rule of thumb:

NRTis end in 'ine'

Pis: end in 'vir'
NNRTis: nevirapine, efavirenz

H IV: anti--retrovirals · P450 interacbon

nevirapine (a NNRTI)· induces P450

protease inhibitors: inhibits P450

HOCM - drugs to avoid: nitrates, ACE-inhibitors, inotropes

HOCM ·poor prognostic factor on echo =septal wall thickness of> 3cm

HOCM is the most common cause of sudden cardiac death in the young

HRT: Oilddmg a progestogen increases the risk of breast cancer

HRT: unopposed oestrogen increases risk of endometrial cancer

HUS or TTP? Neuro signs point towards TTP

Haemochromatosis is autosomal recessiv e

Haemochromatosis is more common than cystic fibrosis

Haemolytic uraemic syndrome- classically caused byE coli 0157:H7

Hashimoto's thyroiditis= hypothyroidism-+- goitre+ anti-TPO

Hashimoto's thyroiditis is associated with thyroid lymphoma

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 lichen

planus: purple, pruritic, papular, polygonal rash on ftexor surfaces. WicKham's striae over surface. Oral
involvement common
sclerosus: 1tchy white spots typically seen on the vutva of elderly women

Liddle's syndrome: hypokalaemia +hypertension

likelihood ratio for a posrtive test result =sensitivity I (1 - specifidty)

Limited (central) systemic sclerosis= anti-centromere cmlibodies

lithium: fine tremor in chronic treatment, coarse tremor in acute toxicity

live attenuated vaccmes

BCG
MMR
oral polio
yellow fever
oral typhoid

Lofepramine - the safest TCA in overdosage

long QT syndrome - usually due to loss-Qf-functionlblockage of K... channels

loss of corneal reflex - think acoustic neuroma

lung adenocarcinoma

most common type in non-smokers

peripheral lesion

Macular degeneration- smoking is risk factor

Magnesium sulphate- monitor reRexes + respiratory rate

Main indication for HRT: control of vasomotor symptoms

Man returns from trip abroad with maculopapular rash and flu-like illness - think HIV seroconversion

Management of venous ulcera! ion -compression bandaging

Massive PE +hypotension - thrombotyse

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 TNF-o inhibitors m~y reactivate TB

Streptococcus pneumoniae is associated with cold sores

Chlamydia- treat with azithromycin or doxycydine

E. coli is the most common cause of travellers' diarrhoea

H. pylon· eradication:

PPI +- amoxidllin + clarithromycin, or

PPI +metronidazole+ clarithromycin

Saccharopolyspora rectiv,rgula causes farmer's lung, a type of EAA

Streptococcus bovfs endocarditis is assOOated with colorectal cancer

ACE inhibitors have reduced efficacy in black patients and are therefore not used first..fine

AOPKD type~ =chromosome 16 = 85% of cases

AOPKD type 2 = chromosome 4 = 15% of cases

ATN or prerenal uraemia? In pre renal uraemia think of the kidneys holdmg on to sodium to preserve volume

Absence seizures - good prognosis: 90-95% become seizure free in adolescence

Absolute risk reduction =(Control event rate) - (Experimental event rate)

Acne rosacea treatment:

mild/moderate: topical metronidazole

severe/resistant: oral tetracycline

Acromegaty: increased sweating is caused by sweat gland hypertrophy

Activated protein C resistance (Factor V Le1den) is the most common inhented thrombophilia

Acute angle closure glaucoma is associated with hypermetropia, where as primaJY open-angle glaucoma 1s
associated with myopia

Acute myeloid leukaemia- good prognosis: 1(15;17)

Acute myeloid leukaemia - poor prognosis: deletion of chromosome 5 or 7

Acute promyek)cylic leukaemia - t(15;17)

Addison's d•sease is associated with a metabolic acidosis

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Adenosine

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 Collapse+ ARF __,. rhabdomyotysis · treat with IV fluids

Cotorectal cancer screening- PPV of FOB = 5- 15%

Combined 8- and T-cell disorders: SCID WAS ataxic {SCID, Wiskoti-Aidrich syndrome, ataxic telangiectasia)

Complete heart block causes a variable Intensity of S1

Complete heart block following a Ml? - right coronary artery lesion

Complete heart block following an inferior Ml is NOT an indication for pacing, unlike with an anterior Ml

Congemtal heart disease

cyanotic: TGA most common at birth, Fallot's most common overall

acyanotic: VSD most common cause

Congenital rubella

sensonneural deafness
congenital catarads

Congemtal toxoplasmosis

cerebral calcification
chorioretinitis

Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5. MALIGNANT pleural effusion, and
vocal cord paralysis

Cushing's syndrome- hypokalaemic metabolic alkalosis

Cydophosphamide- haemorrhagic cystitis- prevent w•th mesna

Cytomegalovirus IS the most common and Important viral infection in solid organ transplant recipients

OVLA advice following ;,ngioplasty. unnot dnve for 1 week

OVLA advice post CVA: cannot drive for 1 month

DVLA advice post Ml - cannot drive for 4 weeks

DVLA advice post multipler T IAs: cannot dnve for 3 months

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 Deletion of chromosome 15

Prader-Willi- paternal
Angelman syndrome - m aternal

Dentistry in warfarinised patients -check INR 72 hours before procedure, proceed if INR < 4.0

Dermabtis herpetrformis • Cilused by lgA deposition in the dermis

Dermatomyositis antibodies: ANA most common. anti-Mt-.2 most specific

Dermatophyte nail infections- use oral terbinafine

Oesmopress1in - induces release of von Wllle brand's factor from endothelial cells

Deterioration in patient with hepatitis B - ?hepatocellular carcinoma

DiGeorge syndrome- aT-cell disorder

D ia betes diagnosis: fasting > 7.0, random> 11.1 - if asymptomatic need two readings

Diabetes mellitus- HbAtc of 6 .5% or greater is now d1agnostic (WHO 2011)

Diarrhoea -+- hypokalaemia -+ villous adenoma

Diarrhoea - biospy shows pigment laden macrophages =laxative abuse

Diffuse prolrterative glomerulonephritiS IS the most common and severe form of re nal d1sease in SLE patients

D iffuse prolrterative glomerulonephritis, causes:

post-streptococcal
SLE

Digoxin- inhibits the Na·JK· ATPase pump

D ipyridamole is a non-specific phosphodiesterase inhibitor and decreases cellular uptake of adenosine

D is coid lupus erythematous - topical steroids - oral hydmxychlomquine

Disproportionate mterocyt1c anaemia -think beta-thalassaemia t ra1t

Oosulepin - avoid as dangerous ln overdose

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 Molecular biology techniques

SNOW (South - NOrth - West)

DROP (DNA- RNA- P roteon)

Most common cau:~-e of endocarditis:

Staphylococcus aureus
Staphylococcus epidermid1s if < 2 months post valve surgery

Most common organism found in central line infections- Staphyfococcus epidennfdls

Motion .sickness- hyoscine > cyclizine >promethazine

Motor neuron disease - filuzole

Motor neuron disease- treatment: NIV is better than riluzole

Mucocutaneous ulceration followmg travel? ·Leishmania brasiliensis

Mumps meningitis is associated with a low CSF glucose

Mycoplasma pneumonia rf allergic/intolerant to macrolides- doxycycline

Mycoplasma?· serology is diagnostic

Myelofibrosis- most common presenting symptom -lethargy

Myoglobin rises first following a myo~rdial 1nhlrction

N ICE recommend avoiding lactulose in the management of IBS

N ICE recommend co-prescrib1ng a PPI with NSAIDs in all pat1ents wrlh osteoarthnhs

NNT =- 1/ Absolute Risk Reduction

Nephrotic syndrome -malignancies cause membranous g lomerulonephritis

NephrotiC syndrome in chtldren I young adutts- minimal change glomerulonephntis

Neuroirnaging is required to diagnose dementia

Nicotinic acid increases HDL levels

Nitric oxide- vasodilation -+- tnhiblts platelet aggregation

Normal p02 but decreased oxygen saturation is characteristic of methaemoglobinaemia

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 Second heart sound (52)

loud: hypertension
soft: AS
fixed split: ASD
reversed split: LBBB

Septic arthritis - most corTVnon organism: Staphylococcus aureus

Septic arthritis: IV fluck>xacillin

Senal peak flow measurements at work and at home are used to detect occupabonal asthma

Severe falciparum malaria- intravenous artesunate

Severe hepahtls 1n a pregnant woman - think hepatitis E

Severe pre-eclampsia- restrict fluids

Shoulder abduction - deltoid muscle - axillary nerve (C5,C6)

Skewed d•stnbubons

alphabetical order: mean - median - mode

'>'for positive. '<'for negative

Sklep apnoea causes include obesity and macroglossia

Small cell lung cancer e~ooounts 50-75% of case of ectopicACTH

Spontaneous bacterial peritonitis- intravenous cefotwe~me

Standard error of the mean= standard deviation I square root (number of patients)

Statins + erythromycin/clarithromycm- an important and common interaction

Statins Inhibit HMG-CoA reductase, the rate-limrting enzyme in hepatic cholesterol synthesis

Stroke thrombolysis -only consider if less than 4.5 hours and haemorrhage excluded

Sudden death, unusual collapse in young person-? HOCM

Supportive therapy is the mainstay of treatment in Cryptosporidium diarrhoea

Symptom control in non-CF bronchiectasis- inspirCJtory muscle training+ postural drainage

Syringomyelia- spinothalamic sensory loss (pain and temperature)

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 Tricyclic overdose - give IV bicarbonate

Trigeminal neurCJigia- carbamazepine is first·line

T rimethoprim may cause pantcytopaenia

Turner's syndrome- most common cardiac defect is bicuspid aortic valve

URTI symptoms + amoxicillin - rash ?glandular fever

U lc erative colitis- the redum is the most common site affected

U ltrasound is the screening test for adult potycystic k•dney d1sease

Unexplained symptoms

Somatisahon = Symptoms
hypoChondria =Cancer

Urea breath test- no antibtotics in past4 weeks, no a ntisecretoty drugs (e.g. PPI) in past 2 weeks

U rethritis+ arthritis+ conjunctivitis= reactive arthritis

Urinary histamine is used to diagnose systemic mastocytosis

Urinary incontinence +gait abnonnahty + dementia= normal prenure hydrocephalus

V for Vigabatnn- V for Visual field defects

Venous thromoboembolism - length of warfarin treatment

provoked (e.g. recent surgery): 3 months

unprovoked: 6 months

Ventricular tachycardia- verapamil is contraindicated

Viagra?- contraindicated by nitrates and nicorandil

Vincnstine- peripheral neuropathy

Visual changes secondary to drugs

blue VISion: Viagra \the blue p ill')

yellow-green vision: digoxin

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 Adenosine

dipyridamole enhances effect

aminophylline reduces effect

Adrenal cortex mnemonic: GFR - ACD

Adrenaline Induced ischaemia -phentolamine

Alcohol w ithdrawal

symptoms: 6-12 hours

se1zures: 36 hours
delirium tremens: 72 hours

Allopurinol inhibits xanthine oxtdase

Alpha-1 antl1rypsin deficiency - autosomal recess•ve I co-dominant

Alport's syndrome - X-linked dominant {in the majority)

Alport's syndrome -type IV collagen defect

Am1odarone • MOA: blocks potass1um channels

Amylase: breaks starch down to sugars

Anal fissure - topical glyceryl trinit rate

Anaphylaxis - serum tryptase levels rise following an acute episode

Anaphylaxis= type I hypersensitivity reaction

Anaplastic thyro id cancer· aggressive, difficult to treat and often causes pressure symptoms

Angiodysplasia is associated with aortic stenosis

Animal bite· co-amoxicJav

Anky1osing spondylitis - x-ray findings: subchondral erosions, sderosis

e~n d squaring of lumbar vertebrCJe

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 Key Points

Wilson's disease- serum caeruloplasmin is decreased

'Fasciculations' ·think motor neuron d•sease

24hr oesophageal pH monitoring is gold standard investigation in GORD

AlP- porphobilinogen deAminase: PCT- uroporphyrinogen deCarboxylase

Chorea rs caused by damage to the basal ganglia . in particular the Caudate nucleus

Drusen = Dry macular degeneration

distal weakness initially

autosomal dominant
diabetes
dysarthria

Goodpasture's syndrome

lgG depos1ts on renal biopsy

anti-GBM antibodies

Legionella pneumophitia IS best d•agnosed by the urinary antigen test

PHaeochromocytoma -give PHenoxybenzamine before beta---blockers

Schistosomiasis is a risk factor for Squamous cell bladder cancer

Stag-hom calcuh

composed of Struvite (ammonium magnesium phosphate. triple phosphate)

fonn in alkaline urine (ammonia producing bacteria such as Ureaplasma urealyticum and Proteus therefore
predispose}

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 Cat scratch disease • caused by Bartonella hense/ae

Causes of raised prolactin - the p's

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
phenothiazines. metodopramide, domperidone

Causes of villous atrophy (other than coeliacs): troptcal sprue, Whipple's, lymphoma. hypogammaglobulinaem•a

Centllll retinal vEun occlusion - sudden painless loss of vision, severe retinal haemorrhages on fundoscopy

Cephalosporins are now the treatment of choice for Gonorrhoea

Cephalosporins, not just dlndamycln, are strongly linked to Clostridium difficile

Cetuximab · monoclonal antibody against the epidermal growth factor receptor

Chickenpox exposure in pregnancy - first step is to check antibodtes

Chickenpox exposure when pregnant · if not immune g•ve VZJG

Chronic myeloid leukaemia- imatinib = tyrosine kinase inhibitor

Ciclosporin + tacrolimus- MOA: inhibit cak:ineurin thus decreasing IL-2

Ciclosponn- decree~ses IL-2 release by inhibiting CC~Icineurin

Ciclosporin side-effects: everything is increased -fluid, BP, K-, hair, gums, glucose

C iprofloxacin - tendinopathy

Cisplatin is associated with hypomagnesaemia

Cisplatin may cause peripheral neuropathy

C lop•dogrel inhtb1ts ADP bmding to platelet reuptors

Clozapine is no longer used first-line due to the risk of agranulocytosis

C luster he011dache- acute treatment subcutaneous sumatriptan + 100%02

Coeliac d isease- tissue transglutaminase antibodies first-line test

Cohort studies -relative risk

1114
Collapse+ ARF --. rhabdomyolysis - treat w ith IV fluids

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 Brush border enzymes;

maltase: glucose+ glucose

sucrase: glucose+ fructose
lactase: glucose+ galactose

Bupropion: contraindicated in epilepsy

Burkllt's lymphtll'ml • c-myc gene translocation

Surkrtfs lymphoma is a common cause of tumour lysis syndrome

Burning thigh pain - ? meralgia paraesthetica - lateral cutaneous nerve of thigh compression

CKD on haemod&alysis - most likely cause of death is IHD

CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR

CLl- immunophenotyping •s investigation of choice

Cll- treatment: Fludarab&ne, Cyclophosphamide and Rituximab (FCR)

CLL is caused by a monoclonal proliferation of 8-celltymphocytes

CML- Philadelph•a chromosome- 1(9:22~

COPD- LTOT if2 measurements ofp02 < 7.3 kPa

COPD - reason for using inhaled corticosteroids -reduced exacerbations

COPD- still breathless despite using inhalers as required?

FEV1 > 50%: lABA or LAMA

FEV1 <50%: lABA + ICS or LAMA

CT head showing temporal lobe changes· think herpes simplex encephalitis

CTPA is the first line investigation for PE according to current BTS guidelines

Calcium channel blod<ets · side-effects: headache, flushing, ankle oedema

Calcium channel blockers are now preferred to thiazldes in the treatment of hypertension

Cancer patients with VTE- 6 months of LMWH

Carbon monoxide poisomng -most common feature= headache

Case-control studies -odds ratio

1113
Cat scralch disease · caused by Bartoneffa henselae

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 AortJc stenos1s- most common cause·

younger patients < 65 years: bicuspid aortic valve

older patients > 65 years: calcification

Aortic stenosis management: AVR if symptomatic. otherwise cut-off is gradient of 40 mmHg

Aspergillus clavatus causes matt workers' lung. a type of EAA

Aspirin is a common cause of urt.Jcaria

Asthma - intermediate probability • do spirometry firsHine

Asthma d1agnosis ·if high prob~bll1ty of ;e~sthma -start treatment

Asymmetrical symptoms suggests idiopathic Parkinson's

Atrial fibrillation· cardioversion: amiodarone + flecainide

Atrial fibrillation: rate control ·beta blockers preferable to d.goxin

Atrial myxoma • commonest site =left atrium

Atrial natriuretic pept1de ·powerful vasodilator

Atypical antipsychotics commonly cause wetght gain

Atypical lymphocytes - ?glandular fever

Autosomal recessive conditions are 'metabolic'- exceptions: inherited ataxias

Autosomal dominant conditions are 'structural' • excephons: hyperlipidaemia type II, hypokalaemic periodic
paralysis

Azathioprine- d"leck thiopurine methyltransferase deficiency (TPMn before treatment

B· type natriuretic peptide is mainly secreted by the ventricular myocardium

BNP • actions:

vasodilator
diuretic and natriuretic
suppresses both sympathetic tone and the remn-angiotensin-aldosterone system

Bacterial vaginosis- overgrowth of predominately Gardnerella vagina/is

Bacterial vaginosis: oral metronidazole

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 Visual field defects:

left homonymous hemianopia means visual f.eld defect to the left, i.e. lesion of right optic tract
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)
incongruous defects= optic tract lesion; congruous defects= optic radiation lesion or occipital cortex

Vitamin 812 is actively absorbed in the terminal Heum

Warfann ·clotting factors affected mnemonic · 1972 (10, 9 , 7, 2)

Waterlow score- used to identify patients at risk of pressure sores

Whipple's d1sease: jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff (PAS) granules

Wilson's disease · autosomal recessive

Wiskoti-Aidrich syndrome

recurrent bactenal1nfections (e.g. Chest)

eczema
thrombocytopaenia

Women with pulmonary hypertension should avoid becoming pregnant due to very high mortality levels

X-linked conditions: Ouchenne/Becker, haemophHia, G6PD

X-linked recessive conditions - no male-to-male transmission

X-linked recessive conditions- there is no male-to-male transmission. Affected males can only have unaffected
sons and carrier daughters

Young man with Af, no TIA or risk factors, no treatment is now preferred to aspirin

Zero-order (saturation) kinetics

phenytoin
alcohol

Zollinger-Elhson syndrome: eptgastric pain and diarrhoea

cANCA =granulomatosis with polyangiitis: pANCA = Churg-Strauss +others

eGFR vanables -CAGE - Creatinine. Age, Gender, Ethnicity

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 FVC is used to monitor respiratory function 10 Guillain-Barre syndrome

Factor V Leiden mutation results in activated protein C resistance

Finasteride treatment of BPH may take 6 months before results are seen

Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys ...... renal artery stenos1s- do MR
angiography

Flashes and Roaters- vitreous/retinal detachment

Flexural psoriasis - topical steroid

Flow volume loop is the investigation of choice for upper airway compression

Flucloxacillin + co-amoxidav are well recognised causes of cholestasis

Fluctuating confusion/consciousness?- subdural h.;iematoma

Fluctuating consciousness= subdural haemorrhage

Flushing, dianhoea, bronchospasm, tricuspid slenosis, pellagra ---- carcinoid with liver mets- diagnosis: urinary 5-
HIAA

Foam cells are fat-laden mC~crophages

Fomepizole- used in ethylene glycol and methanol poisoning- competitive inhibitor of alcohol dehydrogenase

Funnel plots- show publication bias in meta-analyses

Gallop rhythm (S3) is an earty sign of LVF

Gastric MALT lymphoma - eradicate H. pytori

Gastric adenocarcinoma -signet nng cells

Genital ulcers

painful: herpes much more common than chancroid

painless: syphilis more common than tymphogranuloma venereum +granuloma inguinale

Genital wart treatment

multiple, non-«.eratinised warts: topical podophyllum

solitary, keratinised warts: cryotherapy

Genital warts- 90% are caused by HPV 6 & 11

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 Porphyna cutanea tarda

blistering photosensitive rash

hypertrichosis
hyperpigmentation

Positive predictive value = TP I (TP + FP)

Post-exposure prophylaxis for HIV: oral antiretroviral therapy for 4 weeks

Post-natal deprenion is seen •n •round 10% of women

Power = 1 -the probability of a type II error

Preceding Influenza predisposes to Staphylococcus aureus pneumonia

Primary biliary cirrhosis - the M rule

lgM
anti-Mitochondrial antibodies, M 2 subtype
Middle aged females

Primary percutaneous coronary intervention is the gold-standard treatment forST -elevation myocardial infarction

Prinzmetal angina - treatment= dihydropyrid•ne calcium channel blocker

Progressive supranuclear palsy: parkinsonism, impairment of vertical gaze

Prolactin - under continuous inhibition

Prosthetic heart valves· ant1thrombotic therapy:

bioprosthetic: aspirin
mechanical: warfarin + aspirin

Prosthetic heart valves - mechanical valves last longer and tend to be given to younger patients

Pseudogout - positively birefnngent rhombokl shaped crystals

Psoriasis: common triggers are beta-blockers and lithium

Pulmonary arteries vasoconstrid in the presence of hypoxia

Pulmonary embolism- CTPA is first-line investigation

Pulmonary embolism- normal CXR

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 Drug metabolism

phase 1: o xidation, reduction, hydrolysiS

phase II: conjugation

Dry skin is the most common skle-effect of isotretinoin

During Ramadan, one-third of the normal metformin dose should be taken before sunrise a nd t¥/o-thirds should be
taken after sunset

Dysphagia affec1ing both solids and liquids from the start · think achalasia

EBV: nsociated malignancies:

Burkitt's lymphoma
Hodgkin's lymphoma
nasopharyngeal carcinoma

Eclampsia· give magnesium sulphate first-line

Endometrial cancer Is the second most common association of HNPCC after colorectal cancer

Epidermis- Slayers- bottom layer= stratum germinativum which gives rise to keratinocytes and contains
melanocytes

Epidural haematoma - lucid Interval

Epilepsy + pregnancy = 5mg folic aod

Epilepsy medica!Jon: first-line

generalised seizure: sodium valproate

partial seizure: carbamazepine

Episodic eye pain, lacrimation, nasal stuffiness occurring daily - cluster headache

Erythema nock>sum is associated with a good prognosis in sarcoidosis

Essential tremor is an AD condition that is made worse when anns are outstretched, made better by alcohol and
propranolol

Ethylene glycol toxicity management- fomepizole. Also ethanol/ haemod1alysis

Exenatide =Glucagon-like peptide-1 (GLP-1) mimetic

Exenatide causes vomiting

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 TTP- plasma exchange is first~ line

Tachycardia with a rate of ~50/min ?atrial flutter

Taxanes (e.g. 004;etaxel) prevent microtubule dtsassembty

Tear-drop poikilocytes =myelo fibrosis

Ter1tpressin - method of action = constrictiOn of the splanchnic vessels

The PTH level in primary hyperparathyroidism may be normal

The diagnostic test for acromegaly is an oral glucose tolerance with growth hormone measurements

The gold standard test for achalasia is oesophageal manometry

The majority of patients with sarcoidosis get better without treatment

The overnight dexamethasone suppression test is the best test to diagnosis Cushing's syndrome

The short synacthen test is the best test to diagnose Addison's disease

The sulfamethoxazole in co-trimoxazole causes haemolysis in G6PD, not the trimethoprim

The vast maJority of gout IS due to deaeased renal excretiOn of uric acid

Thiazkles cause hypercalcaemia

Thyrotoxicosis wilh tender goitre= subacute (De Quervain's) thyroiditis

Ticagrelor has a similar mechanism of action to clopklogrel- inhibtts ADP binding to platelet receptors

Topical steroids

moderate: Clobetasone butyrate 0.05%

potent: Betamethasooe valerate 0. ~ %
very potent: Clobetasol propionate 0.05%

Transfer factor

raised: asthma, haemorrhage, left-to-right shunts, potycythaemia

low: everything e lse

Trastuzumab (Herceptin)- cardiac toxidty is common

Trastuzumab (Herceptin)- monodonal antibody that acts on the HER21neu receptor

Treatment of acute glaucoma- acetazolamide+- pilocarpin e

1132

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