What genes are associated with Crohn’s? What other risk factors are there?
NOD2 (chromosome 16) & HLA-B27.
Smoking, refined sugar intake, autoimmune disease, female.
Describe the pathology seen in the GI tract of a Crohns patient.
Skip lesions anywhere along the GI tract. Cobblestone mucosa: mucosal oedema and ulceration with ‘rose-thorn’ fissures. Transmucosal. Granulomatous.
What extraintestinal complications can occur in IBD?
Uveitis, episcleritis, gallstones, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, amyloidosis.
How do you treat an acute exacerbation of Crohns?
Fluid resus, IV corticosteroids, high dose 5-ASA analogues, analgesia, parenteral nutrition if required.
What are the risk factors of UC?
FHx, increased serum pANCA, primary sclerosing cholangitis, autoimmune diseases.
Treatment for Acute Cholecystitis?
analgesia (not morphine), antiemetics, IV fluids, NBM, IV antibiotics (Cephalosporin). Cholecystectomy
Treatment for Acute ascending cholangitis?
Analgesia (not morphine), antiemetics, IV fluids, NBM, IV antibiotics (cefuroxime & Metronidazole). Urgent biliary drainage if obstruction is present. Cholecystectomy
Causes of pancreatitis?
Gall stones, Ethanol, Trauma, Steroids, Mumps, Autoimmune conditions, Scorpion Venom, Hyperlipidaemia, Hypercalcaemia, ERCP, Drugs Pregnancy
Assessment of Pancreatitis Severity
PaO2 55y, Neutrophils >15x10/L, Calcium 16 mmol/L, Enzymes(LDH) >600 units, Albumin 10g/L 3 positive factors within 48h of onset, should be transferred to ITU
What is the treatment of Pancreatitis?
NBM, analgesia, IV fluids, hourly monitoring
What are the causes of Liver Failure?
HALTED: Hepatitis Viral, Autoimmune Hepatitis, Leptospirosis (infection), Toxins, Enzyme deficiency (antitrypsin deficiency), Drugs (Paracetamol, isoniazid, halothane)
What are the signs of Chronic Liver Disease?
Ascites/Asterixis/ankle oedema, Bruising, Clubbing, Dupuytren’s Contracture, Erythema (palmar)/Encephalopathy, hepatic Foetor, Gynaecomastia, Hepatosplenomegaly/Hair loss, Increase in parotid sice, Jaundice
Signs of severe alcohol withdrawal
“When Sergy halts his habit madness runs amok” Wernickes encephalopathy, Seizures, Hypoglycaemia, Hypokalaemia, Hypocalcaemia, Malnutrition, Respiratory Alkalosis
What is the treatment of severe alcohol withdrawal?
Chlordiasepoxide (po), Pabrinex (IV)
DDx of Hepatomegaly
Cancer, Cirrhosis, Congestive cardiac failure, Constrictive pericarditis, Infiltration: fatty infiltration, haemochromatosis, amyloidosis, sarcoidosis, lymphoproliferative diseases
DDx of Splenomegaly
Portal Hypertension, Haematological, Infection (Malaria, TB, Infective Endocarditis, Infectious mononucleosis, Brucellosis), Inflammation (Sarcoidosis)
DDx of Abdominal Distension
Fat, Faeces, Fluid, Flatus (obstruction), Foetus, Full-sized tumour, Full bladder, Fibroids
DDX of Haematemesis
Peptic Ulcer Disease, Gastroduodenal erosions/ulcers, Mallory-Weiss tear, Varices, Upper GI bleed, Vascular malformation, Hereditary telengectasia
Hair loss on the scalp with a characteristic margin of exclamation mark hair shifts.
Alopecia Areata
Benign overgrowth of fibroblastic tissue following skin injury, causing an excessively large scar. More common in Afro-Carribeans.
Keloid Scarring
Fleeting erythematous rash, associated with fever cracked lips, red tongue, swollen hands, and swollen neck glands.
Kawasaki Disease (can lead to development of coronary artery aneurysms if not treated)
Itchy lesion with an irregular edge, raised surface and variable pigmentation. Changing shape and size and can bleed.
Melanoma
Slow growing ulcerated lesion with rolled pearly edges and telengiectasia. Normally on sun exposed area.
Basal Cell Carcinoma
What is Koilonychia and what does it indicate?
Spoon shaped nails, Iron deficiency Anaemia
What are the cardiac causes of clubbing?
Atrial myxoma, aneurysms, congenital CHF, infective endocarditis
What nerve is damaged? Wrist drop and loss of sensation in the anatomical snuff box.
Radial nerve injury
Loss of sensation in thumb, index, middle and lateral half of ring finger. What nerve is damaged?
Median nerve injury
Claw hand deformity and loss of sensation in little finger and medial half of ring finger. What nerve is injured?
Ulnar Nerve
What is Grad 1, 2 and 3 HTN? (Diastlic, Systolic)
Grade 1 = 140-159/90-99
Grade 2 = 160-179/100-109
Grade 3 >180/110
What are the 2 types of HTN, and how are they different?
V-hypertension = predominantly Na-volume mediated; direct renin 5uU/ml
How are V-hypertension and R-hypertension treated differently?
V-HTN = diuretics and vasodilators (CCBs, alpha blockers) R-HTN = ACEI, ARB, B-blockers
What is the immediate treatment for an MI? What other intervention can be offered for a STEMI
Morphine, Metaclopramide, Oxygen, Nitrates, Antiplatelets (Aspirin, Clopidogrel, Fondaparinux), B-blocker (unless CI)
PCI (percutaneuous coronary intervention) for STEMI
What is considered a normal and a high normal blood pressure?
120-129/80-84
130-139/85-89
AFTER AN ECG, what is the next investigation you should do on someone with a suspected MI?
Blood Test: Troponin (highest 8 hours after MI), serum cholesterol, FBC, U&Es (K), CRP, Glucose, CKMB
What is the most important biomarker to check for a patient with chest pain and a previous heart attack in last 2 weeks?
CK-MB, less specific than troponin but is only raised for 3 days after an MI (troponin raised for 10 days)
MI complications
Death, Arrhythmia, Rupture (of septum or outer walls), Tamponade, Heart Failure, Valve disease, Aneursym, Dressler’s Syndrome (autoimmune pericarditis 2-10 weeks after), Embolism, Re-infarction
Causes of ST elevation?
Normal variant, Electrolyte imbalance, LBBB, Early Repolarization, Ventricular Hypertrophy, Aneurysm, Treatments, Injury (MI), Osbourne waves (hypothermia), Non-Occlusive vasospasm (Prinzmetal’s angina)
What is the normal QRS duration?
What are the causes of RAD?
RVH, Pulmonary Embolism, Anterolateral MI, WPW syndrome, Left posterior hemiblock
ST depression in leads II, III, and aVF during exertion indicates what? What is the most likely pathology behind this finding?
Inferior myocardial ischaemia, most likely due to a ricght coronary artery occlusion
How do you present an ECG?
This is a 12 lead ECG of Mr/Mrs… presenting with… taken on…
Rate… Rhythm… Axis…
P wave, QRS complex, PR interval, QT interval
ST segment, T wave.
In conclusion this is a 12 lead ECG of Mr.. Presenting with… showing… which is consistent with..
Causes of LAD on ECG?
Left anterior hemiblock, Inferior MI, VT from LV focus, LVH, WPW sydrome
Causes of LAD on ECG?
Left anterior hemiblock, Inferior MI, VT from LV focus, LVH, WPW sydrome
What are the main symptoms of digoxin toxicity?
confusion, irregular pulse, loss of appetite, nausea, vomiting, diarrhea, palpitations, vision changes
ST depression in leads V1-V3 with a dominant R wave in V2 indicates what? What is this patient also likely to be suffering from?
Posterior MI, rarely occur alone, so likely to accompany an inferior or lateral infarction.
23yo F, 24h RIF pain. Tenderness and guarding in RIF. No menstrual symptoms. Abdominal and Pelvic US are normal. Initial DDx and managment?
Ectopic Pregnancy, Acute appendicitis.
Should do a FBC and urine sample (hCG), if this is not an option the next best investigation is a diagnostic laparoscopy.
30yo M, severe colicky left loin pain, radiated to left groin. Initial ddx and investigation?
Renal colic. Unless, pregnant, CT scan is best option, otherwise would do renal US. Haematuria will also be present in 90% of cases.
45yo man, sudden onset epigastric pain, constant. Had several previous episode. Drinks half a bottle of whisky a day. Initial DDx and Investigation?
Acute Pancreatitis.
Serum amylase is key to diagnosis. CT may help show more specific complications.
What are the causes of ST depression?
Mitral Valve Prolapse, LV Hypertrophy, Hypokalaemia, Reciprocal ST depression, PE, Subendocardial Ischaemia, Subendocardial Infarct, Encephalon Haemorrhage, Dilated Cardiomyopathy, Shock, Toxicity (Digoxin, Quinidine)
What is Salpingitis and what are the most common causes?
Infection and inflammation of the fallopian tubes, can be split into acute and chronic.
Bacteria: N.gonorrhoea, chlamydia trachomatis, Mycoplasma, Staphylococcus, Streptococcus.
Abnormal smelling vaginal discharge, abdominal pain on having sex, fever, vomiting and nausea. Diagnosis? Investigations?
Salpingitis
Pelvic Exam, vaginal swab and blood tests.
ECG changes after a STEMI
Tented T waves in the affected leads within mins (due to localised hyperkalaemia following myocyte ischemia)
ST elevation lasting 24-48 hours
T wave inversion develops in 1-2 days
Q waves, develop within days and remain permanently
Causes of Pericarditis
Collagen Vascular disease, Aortic aneurysm, Radiation, Drugs (eg Hydralazine), Infections, Acute Renal Failure, Cardac Infarction, Rheumatic Fever, Injury, Neoplasms, Dresslers Syndrome
Jones Criteria of Rheumatic Fever (Major)
Major: Carditis, Arthiritis, Subcutaneous Nodules, Chorea (Sydenhams), Erythema Marginatum, Required = evidence of Strep/recent scarlet fever
Jones criteria of Rheumatic Fever (Minor)
Fever, Rheumatic Fever Hx, Arthralgia, Inflammatory cells, Long PR interval
Main 3 Ddx of raised JVP
Right Heart Failure (or strain due to pulmonary hypertension), Tricuspid regurgitation, Constrictive Pericarditis
Loud systolic murmur, radiates to carotids, ejection click heard at apex
Aortic stenosis (no ejection click if stenosis is due to calcification)
Pan-Systolic murmur, radiates to axilla, SOB, left ventricular hypertrophy
Mitral Regurgitation
Low pitched mid-diastolic murmur radiating to apex, best heard if patient rolled onto left side, tapping apex beat.
Commonest cause?
Mitral Stenosis, Rheumatic Fever
Rumbling murmur increases with inspiration, best heard at lower left sternal edge, little radiation.
Tricuspid Stenosis
High pitched puffing quality, best heard at left 2nd IS with patient leaning forward, radiates down left sternal border.
Aortic Regurgitation
What are the classic triad of symptoms for aortic stenosis?
Angina, exertional syncope, exertion SOB
Ddx of Sinus tachycardia
Sepsis, hypovolaemia, thyrotoxicosis, phaeochromocytoma
SVT Management
1 - Vagal manoeuvre (carotid massage, valsalve manoeuvre)
2 - Adenosine (with continuous cardiac monitoring)
3 - DC cardioversion if evidence of haemodynamic compromise
SVT Management
1 - Vagal manoeuvre (carotid massage, valsalve manoeuvre)
2 - Adenosine (with continuous cardiac monitoring)
3 - DC cardioversion if evidence of haemodynamic compromise
ABCDE Criteria for worrying mole signs
Asymmetry, Border irregularity, colour variegation, diameter >6mm, elevation or enlargement of mole
How do you measure Breslow thickness? At what depth does 5 year survival drop to only 50%?
Granular layer of epidermis to the deepest layer of tumour invasion.
>4mm
Syndrome X?
angina and positive exercised ECG test but normal coronary arteries on angiogram. Possibly caused by structural or functional abnormalities of coronary microvasculature
Prinzmetal Angina
AKA Variant angina: angina at rest that occurs in cycles, caused by vasospasm rather than atherosclerosis. Associated with ST elevation during an attack
Decubitus Angina
Angina on lying down at night, possibly precipitated by cold sheet or increased HR during a dream
Murmur on the back below the left scapula, descending to the abdomen + wide pulse pressure
Aortic Dissection
Risk factors of Aortic Dissection
HTN (90%), aortic atherosclerosis, Connective tissue disease, Congenital cardiovascular abnormalities, Aortitis, Iatrogenic, Trauma
What is aortitis and what are the 5 main causes?
Inflammation of the aorta; Tertiary syphilis, autoimmune vasculitis, giant cell arteritis, Takayasu’s arteritis, RA
Signs of aortic insufficiency?
collapsing ‘water-hammer’ pulse, wide pulse pressure, displaces thrusting apex beat, early diastolic murmur at lower left sternal edge (expiration, sitting forward)
Where/how is Aortic regurgitation best heard?
Lower left sternal border; Patient sitting forward in expiration
Austin Flint mid-diastolic murmur. What is it and what causes it?
murmur over the apex, caused by turbulent reflux (in AR) hitting the anterior cusp of the mitral valve and causing a physiological mitral stenosis
What are Quincke’s and Becker’s sign and when are the seen?
Q = visible pulsation on nail-bed; B = visible pulsation of the pupils and retinal arteries. Seen in Aortic Regurgitation
What are Corrigan’s sign and Muller’s sign when are they seen?
Visible pulsations in the neck (C) and of the uvula (Mullers). Seen in aortic regurge.
How do you medically manage aortic regurgitation?
Vasodilators (e.g Nifedipine) + ACEi
Signs of aortic stenosis? (pulse pressure, carotid pulse, apex, murmurs, thrills…)
narrow pulse pressure, slow-rising carotid pulse, forceful sustained thrusting undisplaced apex beat, palpable thrill in the aortic area, harsh systolic murmur at left sternal border radiating to the carotid artery and apex
How does the Stanford classification divide aortic dissection? Which type has the worst prognosis?
Type A = ascending aorta
Type B = descending aorta, distal to the left subclavian artery.
Type A has worse prognosis and needs emergency surgery due to risk of cardiac tamponade
Management of chronic AF?
B-blocker or Verapamil for rate control (Alternative = digoxin and amiodarone) and Anticoagulation
What does a Swanz-Ganz catheter allow you to measure?
right atrial, right ventricular, pulmonary artery, pulmonary wedge, and left ventricular end diastolic pressure
How do you treat Cardiogenic shock caused by LVF?
Give Noradrenaline, dobutamine and send to ITU
Hx: Dyspnoea, wheeze, cough with pink frothy sputum. O/E: gallop rhythm, fine crackles throughout lung
Acute Left Ventricular failure causing pulmonary oedema
Hx: ankle oedema, fatigue, decreased exercise tolerance, anorexia. O/E: raised JVP, hepatomegaly ascites
Right Ventricular failure
3 types of Cardiomyopathy
Dilated, Hypertrophic, Restrictive
Peripheral Stigmata of Infective Endocarditis
Fever and night sweats, Roth spots, Osler’s nodes, Murmur, Janeway lesions, Anaemia, Nail haemorrhage, Emboli
Cloudy unpleasant smelling urine, dysuria (pain), suprapubic/flank pain, fever, malaise. MHx of chronic vesicoureteric reflux.
Chronic Pyelonephritis = renal inflammation and fibrosis. Can also be caused by DM, renal obstruction and untreated acute pyelonephritis.
1st to 4th line treatment of HTN in
1st = ACEi 2nd = + CCB or diuretic 3rd = + CCB + diuretic 4th = Spironolactone or a-blokcer
5 main characteristics of TTP? Treatment?
Signs: Microangiopathic haemolytic anaemia, thrombocytopenia with purpura, acute renal insufficiency, neurological abnormalities, fever.
Treatment: plasma-exchange therapy
Cystic Fibrosis: genetic inheritance, gene mutation, incidence, micro path, macro path
Autosomal recessive, mutation of CFTR gene (c7q), 1/2500 live births.
CFTR encodes a cAMP dependent Cl- channel, which regulates Na/Cl concentration in exocrine secretions (particularly in lung and pancreas).
Thick viscous secretions cause respiratory tract infections, pancreatic insufficiency, mal-absorption and male infertility.
What bacteria is most often associated with lung infections of CF patients? How does it present? How is it treated?
Pseudomonas aeruginosa, green sputum, Ciprofloxacin + Aminoglycoside
How is CF screened in babys?
Tests for immunoreactive trypsin, which is increased in CF patients
What might you see on a CXR of a patient with CF?
upper lobe fibrosis and increased bronchial markings
2 most common caused of neonatal jaundice?
G6PD deficiency and Hereditary spherocytosis
6 symptoms of scurvy? Treatment?
Spontaneous petechial (small purple spots), bruising, friable gingiva, loose teeth, bone pain, joint effusions. Treatment: Ascorbic acid
5 signs of Henoch-Schonlein syndrome. What would be seen on a renal biopsy?
Most common systemic vasculitis in childhood. Often preceded by an infection
Signs: non-blanching palpable purpura rash (concentrated on lower extremities), colicky abdominal pain, arthralgia, oedema, renal disease symptoms (proteinuria, haematuria)
Characterised by IgA deposition in renal biopsy.
6 symptoms and 4 clinical signs of Solitary aldosterone producing adenoma (AKA Conn’s). Treatment?
Symptoms: muscle weakness, cramps, polyuria, polydipsia, paraesthesia, tetany
Signs: HTN, high aldosterone, low renin, low K
Treatment: Spironolactone, surgical removal of adenoma
CXR of Bronchiectasis may show..
Tram lines and ring shadows
4 signs/symptoms of bronchiectasis
chronic productive mucopurulent cough (smelly green sputum if severe), haemoptysis, clubbing, coarse inspiratory crackles
What would be seen in the LP of someone with bacterial meningitis?
Clear, cloudy or purulent appearance, elevated opening pressure, high WBC (>100), high protein (>50), low glucose (
3 stages of Churg-Strauss Syndrome
1 - airway inflammation: asthma and allergic rhinitis
2 - hypereosinophila: lung and GI tissue damage
3 - vasculitis: cell death
Treatment of Churg Strauss Syndrome
high does glucocorticoids +/- cyclophosphamide/azathioprine
DDx of Collapse
Cardiac: vasovagal, arrhythmias, long QT syndrome, aortic stenosis, HOC, PE, postural hypotension
Neural: seizure
Metabolic: hypoglycaemia
Angina Medical Treatment
1st = B-blocker (e.g. Matoprolol) 2nd = CCB (e.g Verapamil or Nifedipine) 3rd = long lasting nitrate (e.g. Isosorbide nitrate)
List the TYPICAL Community Acquired Pneumonia Pathogens ad most common associations. What is the main antibiotic treatment?
Streptococcus pneumoniae
Haemophilius influenza = COPD
Moraxella c. = COPD
Mycoplasma pneumonia = 4-yearly pandemics
Treatment = Amoxicillin or Clarithromycin
Hospital acquired Pneumonias and their treatment
Pseudomonas aeruginosa = Aminoglycoside + Ciprofloxacin
Gram -ve bacilli e.g Klebsiella
Anaerobes
Treatment = Aminoglycoside + cephalosporin IV
ATYPICAL Community Acquired Pneumonias + Treatment.
Chlamydia pneumonia + C. psittaci = Tetracycline
Legionella pneumophilia = Fluroquinolone + Clarithromycin
Pneumocystis jiroveci = Co-trimoxazole
What is the main aspiration pneumonia and its treatment? Who is at risk of aspiration pneumonia?
Streptococcus pneumonia = Cephalosporin + Metronidazole IV
Risk = those with stroke, myasthenia, bulbar palsies, decreased consciousness, oesophageal disease or poor dental hygiene.
Atypical pneumonia presentations?
headache, myalgia, diarrhoea, abdominal pain
Presentation for Infectious mononucleosis.
Presents: fever, sore throat, fatigue, headache, malaise, pharyngitis, lymphadenopathy, white exudate on tonsils, splenomegaly
Investigations (and findings) in Infectious Mononucleosis
Paul Bunnell/Monospot test = heterophile antibodies
FBC = Leukocytosis
Blood Film = Lymphocytosis
Serology (accurate but rarely needed) = IgM and IgG antibodies
4 defining features of Nephrotic Syndrome
proteinuria (>3.5g/24h), oedema, hypoalbuminaemia, hyperlipidaemia
Peripheral stigmata of Graves Disease (not seen in toxic multinodular goitre).
Thyroid acropachy, periorbital oedema, proptosis, exophthalmos, pretibial myxoedema
Symptoms of Bornholm disease. What is the causative virus?
Fever, attack of severe pain in lower chest exacerbated by movement (pain comes on suddenly and is often one side, can make it hard to breath)
Caused by the Coxsackie B virus
Definition and treatment of paracetamol overdose. best way to test liver function?
> 150mg/Kg or >12g total = Overdose
Treatment = N-acetylcysteine (10% develop allergic reaction), alternative = Methionine
PTT = best indicator of liver damage
Presentation of paracetamol overdose
Initially = nausea, vomiting, lethargy, RUQ pain
At 72h = jaundice, confusion, coagulopathy, hypoglycaemia, hepatomegaly
Signs of Hypercalcaemia
Kidney stones, polyuria, polydipsia, bone pin, constipation, depression, confusion, lethargy
Causes of Hypercalcaemia
90% = hyperparathyroidism or malignancy
Others: Calcium supplements, Immobilisation, Iatrogenic, Multiple Myeloma, Milk-Alkali syndrome, Paget’s disease, Addison’s disease, Zollinger-Ellison syndrome, Excessive Vit A or Vit D, Sarcoidosis
Reasons for dialysis in Acute Kidney Injury
Metabolic acidosis, Hyperkalaemia, Intoxication (Salicylic acid, Lithium, Isopropranol, Mg based diuretics, Ethylene glycol), Fluid overload refractory to diuretics, Signs or uraemia
Aetiology and 4 symptoms of Alport’s Syndrome
Familial nephropathy due to abnormal type IV collagen. Can be inherited in x-linked, AR or AD pattern.
Symptoms: Gross haematuria (precipitated by infection), sensorineural hearing loss, renal failure, central retinopathy
What is Tietze’s syndrome and how does it present? Treatment?
Costochondritis
Insidious onset of anterior chest wall pain, made worse by movement and inspiration. Pain on palpation. Treated with NSAIDs (rule out other ddx).
What investigations are carried out on someone with suspected Nephrotic syndrome? Most common cause?
24h urine protein or spot urine protein-creatinine ration. Renal biopsy needed to make a definitive diagnosis.
Most common cause is Diabetic nephropathy
Occupational lung disease (mining), marked by inflammation and scarring in nodular lesions of the upper lobes of the lung. Presents with SOB, cough, fever and cyanosis
Silicosis - irreversible condition with no cure. Treat symptoms.
10% rule of Phaeochromocytoma
10% bilateral, 10% malignant, 10% extradrenal… 25% hereditary
Genes associated with Phaeochromocytoma
MEN2A, MEN2b, VHL
Clinical signs of Phaeochromocytoma
Increased urinary and serum catecholamines, metanephrines and normetanephrines.
Raised VMA in 24h urine.
DDx of a red eye
Angle glaucoma (painful red eye, vomiting, impaired vision, haloes around light) Uveitis (photophobia, pain, lacrimation, blurred vision) Acute conjunctivitis (itchy red eye)
What would be seen on examination of a patient with Acute closed angle glaucoma?
red eye, hazy cornea, loss of red reflex, fixed and dilated pupil, hard and tender eye, cupped optic disc, visual field defect, raised IOP
3 signs of Felty’s Syndrome
Rheumatoid arthiritis + splenomegaly + neutropenia
Cystic hygroma definition and presentation
Congenital benign collection of lymphatic sacs; cysts contain clear fluid and transilluminate brightly
Presentation: soft, fluctulant lump, transilluminates, normally on posterior triangle of neck
Presentation of Branchial cyst? Investigation?
Non-tender fluctulant swelling anterior to the sternocleidomastoid, at the junction of it’s upper and middle thirds. Can become enlarged and inflamed after a respiratory tract infection
Investigation: fine needle aspiration (creamy yellow turbid fluid containing cholesterol crystals)
Top 5 UK hospital-acquired infections.
MRSA, VRE (Vancomycin resistant enterococci), ESBL, Pseudomonas, Acinetobacter.
Difference between Seminomas and Teratomas.
Seminoma: 30-40yo, arise from seminiferous tubules, B-hCG production
Teratoma: 20-30yo, arise from germ cell tumours, aFP and B-hCG production
Lower Urinary Tract Symptoms
Voiding symptoms: hesitancy, terminal dribbling, weak stream
Storage symptoms: nocturia, frequency, urgency
Symptoms of Wegener’s Granulomatosis
Glomerulonephritis, nosebleeds, hearing loss, gingivitis/oral ulcerations, eye inflammation, haemoptysis, subglottal stenosis, arthiritis, purpura
Definition of cirrhosis
Fibrosis with nodular regeneration
CURB65 scoring
Used in Pneumonias
Confusion, Urea >7mmol/L, RR > 30bpm, BP 65
Abdominal pain, raised IgM, raised ALP and antimitochondrial antibodies.
Primary Biliary Cirrhosis
6 P’s of Acute limb ischaemia
Painful, Pale, Pulseless, Perishing Cold, Paraesthetic, Paralysed
4 condition in Tetrad of Fallot
VSD, Over-riding aorta, RVH, Pulmonary stenosis
LP results of viral meningitis
Clear appearance, high WBC (10-1000), high protein (>50mg), normal glucose (>60%)
LP results of Guillain-Barre
Xanthochromia + high protein
LP results of MS
Oligoclonal bands, slightly high protein
LP results of TB
clear/opaque appearance, high opening pressure, high WBC, low glucose, high protein
LP results of Subarachnoid Haemorrhage
Xanthochromia/bloody appearance, high opening pressure, high protein
6 main types of generalized seizures
GrandMal, Absence, Myoclonic, Clonic, Tonic, Atonic
4 types of partial seizure
Simple Motor, Simple sensory, Simple psychological, Complex
Type of seizure? Loss of consciousness, convulsions, muscle rigidity, tongue biting, incontinence
Grand-Mal / Tonic-Clonic (generalized seizure)
Type of seizure? Loss of consciousness for seconds only, no convulsions
Abscense (Generalized seizure)
Type of seizure? Sporadic/isolated jerking movements ‘like electrical shocks’
Myoclonic (generalized seizure)
Type of seizure? Repetetive, jerking movements involving both sides at the same time
Clonic (Generalized seizure)
Type of seizure? Muscle stiffness and rigidity, no loss of consciousness
Tonic (Generalized seizure)
Type of seizure? loss of muscle tone, particularly arms and legs, often results in a fall
Atonic (generalized seizure)
Type of seizure? Awareness is retained, jerking, muscle rigidity, spasms, head turning
Simple motor (partial)
Type of seizure? Awareness is retained, unusual sensations affecting the vision, hearing, smell, taste or touch
Simple sensory (Partial)
Type of Seizure? impairment of awareness, automatisms such as lip smacking, chewing, fidgeting, walking or other repetitive, involuntary but coordinated movements
Complex partial
2+ episodes of neurological dysfunction separated in time and space (normally temporary visual or sensory loss)
Multiple Sclerosis
Muscle weakness which increases with exercise, diplopia, drooping eyelids, SOB, proximal limb weakness, facial paresis, oropharyngeal weakness.
Myasthenia Gravis
Myasthenia Gravis treatment?
Anticholinesterases & Immunotherapy
Clinical diagnosis of Type 1 Neurofibromatosis (Recklinghausen’s disease)
2/7 of: 6+ café au lait spots, axillary freckling, 2+ neurofibromas, optic glioma, 2+ lisch nodules (iris harmatomas), osseous lesion, Fhx in first degree relative
Acute ascending weakness in a lower motor neurone pattern, absent reflexes
Guillian-Barre Syndrome
Presentation of CLL
recurrent infections, easy bruising, FLAWS, enlarged rubbery non tender lymph nodes, smear cells, lymphocytosis, splenomegaly, +ve direct coombs test
Presentation of CML
sweats, splenomegaly, FLAWS, bruising, epistaxis, abdominal discomfort, early satiety, high WCC, peripheral immature granulocytes, Philadelphia chromosome
Triad of symptoms seen in Wernicke’s
Opthalmoplgia with nystgmus, ataxia, encephalopathy
Causes of Cavitating lung lesions
Infection: TB, Staph, Klebsiella
Inflammation: WG, RA
Infarction: PE
Malignancy
Causes of Mononeuritis Multiplex
(WARDS PLC) Wegeners Granulomatosis, AIDS, Amyloid, Rheumatoid, Diabetes mellitus, Sarcoidosis, PAN, Leprosy, Carcinomatosis
Causes of Polyneuropathies
(DAVID) Diabetes, Alcoholism, Vitamin Deficiency (B1, B12), Infective (Gullain Barre), Inherited (CMT), Drugs (Isoniazid)
Symptoms of Carpal Tunnel syndrome. Which nerve is trapped?
aching pain in hand and arm, paraesthesia in thumb, index and middle fingers, pain relieved by shaking it, worse at night
Best way to diagnose a Mononeuropathy?
Electromyography (EMG)
Signs of Ulnar nerve pathology?
weakness/wasting of medial wrist flexors, can’t cross fingers, claw hand, weak little finger abduction, sensory loss of medial 1 and a half fingers
Signs of radial nerve pathology
Wrist and finger drop with elbow flexed and arm pronated - radial nerve can be damaged by compression against the humerus
Symptoms of Guillain-Barre Syndrome
Hx of recent resp or GI illness
Acute flaccid paralysis, proximal and symmetrical muscle weakness of lower limbs, ascending weakness, diminished reflexes, paraesthesia and numbness, aching/throbbing pain
Main features of Myelofibrosis
Night sweats, fever, weight loss, HEPATOSPLENOMEGALY, LEUKOERYTHROBLASTIC cells, DACROCYTES (tear-drop shaped RBCs), Low Hb
Treatment of Myelofibrosis
Marrow support, stem cell transplant. Median survival = 5years
Signs of Polycythaemia Rubra Vera
Hyperviscosity: headaches, dizziness, tinnitus, visual disturbance. Itch an erythromelagia (especially after a hot bath). Facial plethora, splenomegaly
Treatment of Polycythaemia Rubra Vera
Venesection
Higher risk patients = Hydroxycarbamide
Woman of child-bearing age = a-interferon
Symptoms of bulbar palsy (PBP = 10% of MND)
LMN lesion
flaccid, wasted, fasciculating tongue, absent/normal jaw jerk, absent gag reflex, nasal/hoarse speech, dysarthria, dysphagia
Symptoms of a pseudobulbar palsy (seen in PLS, a type of MND)
UMN lesion
brisk jaw jerk; spastic, slow tongue; spastic, slow dysarthria; increased jaw jerk, increased pharyngeal/palatal reflexes; emotional incontinence and mood change
CXR of patient with CF
upper lobe fibrosis and increased bronchial markings
CXR of patient with Sarcoidosis
Bilateral hilar lymphadenopathy
DDx of CXR showing small calcified nodules in lungs
Varicella pneumonitis, TB, Histoplasmosis, chronic renal failure
Causes of bilateral hilar lymphadenopathy
Sarcoidosis, Infection (TB, pneumoconiosis), Malignancy, Organic dust disease (Silicosis), Extrinsic allergic alveolitis
Cause of upper zone fibrotic shadowing on CXR
TB, Extrinsic Allergic Alveolitis, Ankylosing spondylitis, Radiotherapy, Sarcoidosis
Causes of Mid Zone fibrotic shadowing on CXR
Progressive massive fibrosis
Causes of Lower Zone fibrotic shadowing on CXR
Idiopathic pulmonary fibrosis, Asbestosis
6 symptoms + 2 signs of Waldenstrom’s Macroglobulinamia
Symptoms: Nose bleeds, blurred vision, retinal haemmorhage, weight loss, splenomegaly, cervical lymphadenopathy
Signs: Lymphoplasmacytoid B cells, IgM