Cardiology

Streptococcus bovis endocarditis is associated with colorectal cancer

Aortic dissection
type A - ascending aorta - control BP(IV labetalol) + surgery
type B - descending aorta - control BP(IV labetalol)
Aortic stenosis - S4 is a marker of severity
Aortic stenosis - 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 50 mmHg
Atrial fibrillation - cardioversion: amiodarone + flecainide
Atrial fibrillation: rate control - beta blockers preferable to digoxin
Bosentan - endothelin-1 receptor antagonist
Calcium channel blockers are now preferred to thiazides in the treatment of hypertension
Complete heart block following a MI? - right coronary artery lesion
Complete heart block following an inferior MI is NOT an indication for pacing, unlike with an
anterior MI
Congenital heart disease
cyanotic: TGA most common at birth, Fallot's most common overall
acyanotic: VSD most common cause
DVLA advice following angioplasty - cannot drive for 1 week
DVLA advice post MI - cannot drive for 4 weeks
Flash pulmonary oedema, U&Es worse on ACE inhibitor, asymmetrical kidneys renal
artery stenosis - do MR angiography
HOCM is the most common cause of sudden cardiac death in the young
Hypertension - NICE now recommend ambulatory blood pressure monitoring to aid
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diagnosis
Hypertension - step 4
K+ < 4.5 then spironolactone
K+ > 4.5 then higher-dose thiazide-like diuretic
Inferior MI - right coronary artery lesion
JVP: C wave - closure of the tricuspid valve
Labetalol is first-line for pregnancy-induced hypertension
Methadone is a common cause of QT prolongation
Most common cause of endocarditis:
Streptococcus viridans
Staphylococcus epidermidis if < 2 months post valve surgery
Myoglobin rises first following a myocardial infarction
Patent ductus arteriosus - collapsing pulse
Patients with established CVD should take atorvastatin 80mg on
Prosthetic heart valves - mechanical valves last longer and tend to be given to younger
patients
Second heart sound (S2)
loud: hypertension
soft: AS
fixed split: ASD
reversed split: LBBB
Sudden death, unusual collapse in young person - ? HOCM
Tachycardia with a rate of 150/min ?atrial flutter
Turner's syndrome - most common cardiac defect is bicuspid aortic valve
Ventricular tachycardia - verapamil is contraindicated
Young man with AF, no TIA or risk factors, no treatment is now preferred to aspirin
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Cardiac action potential: phases

Phase 3 - efflux of potassium
Congenital heart disease
Pulmonary valve stenosis is cyanotic
Drug adverse effects

Notes0 / 1

Amiodarone may cause hyperthyroidism

Notes0 / 1

Amiodarone may cause photosensitivity

Notes0 / 1

Amlodipine may cause flushing

Notes1 / 2

Amiodarone may cause thrombophlebitis

Notes0 / 1

Amiodarone may cause slate-grey appearance

Notes0 / 1

Spironolactone may cause precipitation of digoxin toxicity

Drug indications

Notes0 / 1

Cholestyramine , uses include: treatment resistant diarrhoea in Crohn's

disease
Drug mechanism of action
Amiodarone - blocks potassium channels

Notes0 / 1

Notes0 / 1

Ticagrelor - antagonist of the P2Y12 adenosine diphosphate (ADP)

receptor
ECG: coronary territories

Notes1 / 2

Ischaemic changes in leads II, III, aVF - right coronary

Notes0 / 1

Tall R waves V1-2 - usually left circumflex, also right coronary

ECG: pathological changes

Notes1 / 2

PR depression pericarditis

Notes1 / 2

Right axis deviation - Wolff-Parkinson-White syndrome (left-sided

accessory pathway)
Features (cardiovascular disorders)

Notes0 / 1

Patent ductus arteriosus - collapsing pulse

Heart sounds

Notes1 / 2

Reversed split S2 LBBB

Notes0 / 1

Fourth heart sound - aortic stenosis

Notes0 / 1

Soft S2 - aortic stenosis

Notes0 / 1

Fixed split S2 - atrial septal defect

Notes0 / 3

Loud S2 - atrial septal defect

Notes1 / 2

Loud S1 - mitral stenosis

Notes0 / 1

Third heart sound - constrictive pericarditis

Notes0 / 1

Reversed split S2 - WPW type B

Notes0 / 1
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Reversed split S2 - aortic stenosis

Notes0 / 1

Loud S1 - left-to-right shunts

Notes0 / 1

Loud S2 - hyperdynamic states

Notes0 / 1

Fourth heart sound HOCM

Notes0 / 1

Hypertension levels
Blood pressure target (< 80 years, clinic reading) - 140/90 mmHg

Notes1 / 2

Blood pressure target (> 80 years, clinic reading) - 150/90 mmHg

Notes0 / 1

Definition of stage 2 hypertension (Clinic reading) - 160/100 mmHg

Notes0 / 1

Criteria for considering immediate treatment - 180/110 mmHg

Notes0 / 1

Definition of stage 2 hypertension (ABPM/HBPM) - 150/95 mmHg

Hypertension: next step

Notes0 / 1

Poorly controlled hypertension, already taking an ACE inhibitor,

calcium channel blocker and a thiazide diuretic. K+ > 4.5mmol/l increase dose of thiazide diuretic
Infective endocarditis

Notes0 / 1

Colorectal cancer - Streptococcus bovis

Notes2 / 3

Patients with no past medical history - Streptococcus viridans

Notes1 / 2

Prosthetic valves after two months - Streptococcus viridans

JVP

Notes0 / 1

An absent Y descent in the JVP may be caused by cardiac tamponade

Notes0 / 1

A paradoxical rise in the JVP during inspiration may be caused by

constrictive pericarditis
Murmurs

Notes1 / 2

Atrial septal defect - ejection systolic murmur

Notes0 / 1

Graham-Steel murmur (pulmonary regurgitation) - early diastolic

murmur, high-pitched and 'blowing' in character

Notes0 / 2

Ventricular septal defect - holosystolic murmur, 'harsh' in character

Notes0 / 1

Mitral regurgitation - holosystolic murmur, high-pitched and 'blowing' in

Notes0 / 1
character
Pulses
Pulsus parodoxus - severe asthma

Notes1 / 2

Pulsus parodoxus - cardiac tamponade

Notes1 / 2

Slow-rising/plateau pulse - aortic stenosis

Notes1 / 2

Collapsing pulse - patent ductus arteriosus

Notes0 / 2

Bisferiens pulse - mixed aortic valve disease

Notes0 / 1
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Collapsing pulse - hyperkinetic states

Notes0 / 1

Stereotypical histories (cardiovascular disorders)

A 30-year-old man presents with recurrent palpitations and syncope. A
resting ECG shows T wave inversion in V1-3 and epsilon waves. He has
Notes1 / 2
a family history of sudden death - arrhythmogenic right ventricular
cardiomyopathy
A patient develops acute heart failure 5 days after a myocardial
infarction. A new pan-systolic murmur is noted on examination ventricular septal defect
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Notes1 / 2

Clinical Hematology and Oncology

Activated protein C resistance (Factor V Leiden) is the most common inherited thrombophilia
Acute myeloid leukaemia - good prognosis: t(15;17)
Acute myeloid leukaemia - poor prognosis: deletion of chromosome 5 or 7
Acute promyelocytic leukaemia - t(15;17)
Anaplastic thyroid cancer - aggressive, difficult to treat and often causes pressure symptoms
Antiphospholipid syndrome in pregnancy: aspirin + LMWH
Antiphospholipid syndrome: (paradoxically) prolonged APTT + low platelets
Burkitt's lymphoma - c-myc gene translocation
Burkitt's lymphoma is a common cause of tumour lysis syndrome
CLL - immunophenotyping is investigation of choice
CLL - treatment: Fludarabine, Cyclophosphamide and Rituximab (FCR)
CML - Philadelphia chromosome - t(9:22)
Cancer patients with VTE - 6 months of LMWH
Cetuximab - monoclonal antibody against the epidermal growth factor receptor
Chronic myeloid leukaemia - imatinib = tyrosine kinase inhibitor
Cisplatin is associated with hypomagnesaemia
Colorectal cancer screening - PPV of FOB = 5 - 15%
Cyclophosphamide - haemorrhagic cystitis - prevent with mesna
Desmopressiin - induces release of von Willebrand's factor from endothelial cells
Disproportionate microcytic anaemia - think beta-thalassaemia trait

EBV: associated malignancies:

Burkitt's lymphoma
Hodgkin's lymphoma
nasopharyngeal carcinoma
Factor V Leiden mutation results in activated protein C resistance
Gastric adenocarcinoma - signet ring cells
Gingival hyperplasia: phenytoin, ciclosporin, calcium channel blockers and AML
HRT: adding a progestogen increases the risk of breast cancer
Hereditary haemorrhagic telangiectasia - autosomal dominant
Hodgkin's lymphoma - best prognosis = lymphocyte predominant
Hodgkin's lymphoma - most common type = nodular sclerosing
ITP - give oral prednisolone
IgM paraproteinaemia - ?Waldenstrom's macroglobulinaemia
Metastatic bone pain may respond to NSAIDs, bisphosphonates or radiotherapy
Myelofibrosis - most common presenting symptom - lethargy
Oesophageal adenocarcinoma is associated with GORD or Barrett's
Paraneoplastic features of lung cancer
squamous cell: PTHrp, clubbing, HPOA
small cell: ADH, ACTH, Lambert-Eaton syndrome
Patients with Sjogren's syndrome have an increased risk of lymphoid malignancies
Philadelphia translocation, t(9;22) - good prognosis in CML, poor prognosis in AML + ALL
Polycythaemia rubra vera - JAK2 mutation
Polycythaemia rubra vera - around 5-15% progress to myelofibrosis or AML
Polycythaemia rubra vera is associated with a low ESR
Rasburicase - a recombinant version of urate oxidase, an enzyme that metabolizes uric acid
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to allantoin
Screening for haemochromatosis
general population: transferrin saturation > ferritin
family members: HFE genetic testing
TTP - plasma exchange is first-line
Taxanes (e.g. Docetaxel) prevent microtubule disassembly
Tear-drop poikilocytes = myelofibrosis
Trastuzumab (Herceptin) - cardiac toxicity is common
Trimethoprim may cause pantcytopaenia
Venous thromoboembolism - length of warfarin treatment
provoked (e.g. recent surgery): 3 months
unprovoked: 6 months
Vincristine - peripheral neuropathy

Blood film abnormalities

Tear-drop poikilocytes - myelofibrosis
Drug adverse effects

Notes0 / 1

Primaquine may cause haemolysis in patients with G6PD deficiency

Drug mechanism of action

Notes0 / 2

Imatinib - inhibitor of the tyrosine kinase associated with the BCR-ABL

Notes0 / 1
defect
Haemolytic anaemia
Extravascular haemolysis - warm autoimmune haemolytic anaemia
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Notes0 / 1

Clinical Pharmacology
Drug adverse effects
Amiodarone may cause hyperthyroidism

Notes0 / 1

Amiodarone may cause photosensitivity

Notes0 / 1

Amlodipine may cause flushing

Notes1 / 2

Amiodarone may cause thrombophlebitis

Notes0 / 1

Amiodarone may cause slate-grey appearance

Notes0 / 1

Spironolactone may cause precipitation of digoxin toxicity

Drug indications

Notes0 / 1

Cholestyramine , uses include: treatment resistant diarrhoea in Crohn's

disease
Drug mechanism of action

Notes0 / 1

Amiodarone - blocks potassium channels

Notes0 / 1

Ondansetron - 5-HT3 antagonist

Notes1 / 2

Ticagrelor - antagonist of the P2Y12 adenosine diphosphate (ADP)

receptor

Notes1 / 2

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Clinical science
AIP - porphobilinogen deAminase; PCT - uroporphyrinogen deCarboxylase
Absolute risk reduction = (Control event rate) - (Experimental event rate)
Adrenal cortex mnemonic: GFR - ACD
Anaphylaxis = type I hypersensitivity reaction
Anticipation in trinucleotide repeat disorders = earlier onset in successive generations
Antidiuretic hormone (ADH) - site of action = collecting ducts
Autosomal recessive conditions are 'metabolic' - exceptions: inherited ataxias
Autosomal dominant conditions are 'structural' - exceptions: hyperlipidaemia type II,
hypokalaemic periodic paralysis
BNP - actions:
vasodilator
diuretic and natriuretic
suppresses both sympathetic tone and the renin-angiotensin-aldosterone system
Cohort studies - relative risk
Combined B- and T-cell disorders: SCID WAS ataxic (SCID, Wiskott-Aldrich syndrome,
ataxic telangiectasia)
Correlation
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 parametric (normally distributed): Pearson's coefficient

non-parametric: Spearman's coefficient
DiGeorge syndrome - a T-cell disorder
Epidermis - 5 layers - bottom layer = stratum germinativum which gives rise to keratinocytes
and contains melanocytes
Funnel plots - show publication bias in meta-analyses
Hereditary angioedema - C1-INH deficiency
Hereditary angioedema - C4 is the best screening test inbetween attacks
Human genome - 25,000 protein-coding genes
Hypokalaemia - U waves on ECG
Klinefelter's? - do a karyotype
Methaemoglobinaemia = oxidation of Fe2+ in haemoglobin to Fe3+
Mitochondrial diseases follow a maternal inheritance pattern
Molecular biology techniques
SNOW (South - NOrth - West)
DROP (DNA - RNA - Protein)
NNT = 1 / Absolute Risk Reduction
Nitric oxide - vasodilation + inhibits platelet aggregation
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
Osteomalacia
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 low: calcium, phosphate

raised: alkaline phosphatase
Oxygen dissociation curve
shifts Left - Lower oxygen delivery - Lower acidity, temp, 2-3 DPG - also HbF,
carboxy/methaemoglobin
shifts Right - Raised oxygen delivery - Raised acidity, temp, 2-3 DPG
Power = 1 - the probability of a type II error
Prolactin - under continuous inhibition
Pulmonary surfactant - main constituent is dipalmitoyl phosphatidylcholine (DPPC)
Refeeding syndrome causes hypophosphataemia
Relative risk = EER / CER
Renal tubular acidosis causes a normal anion gap
Rheumatoid arthritis - HLA DR4
Rheumatoid factor is an IgM antibody against IgG
Rituximab - monoclonal antibody against CD20
SIADH - drug causes: carbamazepine, sulfonylureas, SSRIs, tricyclics
Skewed distributions
alphabetical order: mean - median - mode
'>' for positive, '<' for negative
Standard error of the mean = standard deviation / square root (number of patients)
The PTH level in primary hyperparathyroidism may be normal
Transfer factor
raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
low: everything else
Vitamin B12 is actively absorbed in the terminal ileum
Warfarin - clotting factors affected mnemonic - 1972 (10, 9, 7, 2)
Wiskott-Aldrich syndrome
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 recurrent bacterial infections (e.g. Chest)

eczema
thrombocytopaenia
X-linked conditions: Duchenne/Becker, haemophilia, G6PD
X-linked recessive conditions - there is no male-to-male transmission. Affected males can
only have unaffected sons and carrier daughters.
Antibodies
Churg-Strauss syndrome - p-ANCA
HLA associations

Notes0 / 1

Rheumatoid arthritis - HLA-DR4

Hormone, enzyme and protein actions

Notes0 / 1

Secretin - increased pancreatic bicarbonate secretion

Infective endocarditis

Notes0 / 1

Colorectal cancer - Streptococcus bovis

Notes2 / 3

Patients with no past medical history - Streptococcus viridans

Notes1 / 2

Prosthetic valves after two months - Streptococcus viridans

Significance tests

Notes0 / 1

Chi-squared test - non-parametric test used to compare proportions or

percentages
Student's t-test - parametric test of paired or unpaired data
Statistical definitions
Specificity - proportion of patients without the condition who have a
negative test result
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Dermatology
Acne rosacea treatment:
mild/moderate: topical metronidazole
severe/resistant: oral tetracycline
Blisters/bullae
no mucosal involvement (in exams at least*): bullous pemphigoid
mucosal involvement: pemphigus vulgaris
Blisters/bullae
no mucosal involvement: bullous pemphigoid
mucosal involvement: pemphigus vulgaris
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Notes0 / 1
Notes0 / 1

Notes1 / 2

Dermatitis herpetiformis - caused by IgA deposition in the dermis

Dermatophyte nail infections - use oral terbinafine
Discoid lupus erythematous - topical steroids oral hydroxychloroquine
Dry skin is the most common side-effect of isotretinoin
Flexural psoriasis - topical steroid
Impetigo - topical fusidic acid oral flucloxacillin / topical retapamulin
Keloid scars - more common in young, black, male adults
Keloid scars are most common on the sternum
Lichen
planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over
surface. Oral involvement common
sclerosus: itchy white spots typically seen on the vulva of elderly women
Management of venous ulceration - compression bandaging
Melanoma: the invasion depth of the tumour is the single most important prognostic factor
Polymorphic eruption of pregnancy is not associated with blistering
Porphyria cutanea tarda
blistering photosensitive rash
hypertrichosis
hyperpigmentation
Psoriasis: common triggers are beta-blockers and lithium
Scabies - permethrin treatment: all skin including scalp + leave for 12 hours + retreat in 7 days
Seborrhoeic dermatitis - first-line treatment is topical ketoconazole
Topical steroids
moderate: Clobetasone butyrate 0.05%
potent: Betamethasone valerate 0.1%
very potent: Clobetasol propionate 0.05%
Urinary histamine is used to diagnose systemic mastocytosis
Waterlow score - used to identify patients at risk of pressure sores
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Stereotypical histories (dermatology)

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An elderly women develops itchy, tense blisters around the flexures.

There is no mucosal involvement - bullous pemphigoid

Notes0 / 1

An elderly Jewish woman develops painful, flaccid, easily ruptured

vesicles and bullae on the skin. They are not itchy and were preceded by Notes0 / 1
mouth lesions - pemphigus vulgaris
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Endocrinology
PHaeochromocytoma - give PHenoxybenzamine before beta-blockers
Acromegaly: increased sweating is caused by sweat gland hypertrophy
Addison's disease is associated with a metabolic acidosis
Bartter's syndrome is associated with normotension
Bilateral idiopathic adrenal hyperplasia is the most common cause of primary hyperaldosteronism
Cushing's syndrome - hypokalaemic metabolic alkalosis
Diabetes diagnosis: fasting > 7.0, random > 11.1 - if asymptomatic need two readings
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Diabetes mellitus - HbA1c of 6.5% or greater is now diagnostic (WHO 2011)

During Ramadan, one-third of the normal metformin dose should be taken before sunrise and twothirds should be taken after sunset
Exenatide causes vomiting
Flushing, diarrhoea, bronchospasm, tricuspid stenosis, pellagra carcinoid with liver mets diagnosis: urinary 5-HIAA
Gitelman's syndrome: normotension with hypokalaemia
Glitazones are agonists of PPAR-gamma receptors, reducing peripheral insulin resistance
Graves' disease is the most common cause of thyrotoxicosis
Haemochromatosis is autosomal recessive
Hashimoto's thyroiditis = hypothyroidism + goitre + anti-TPO
Hashimoto's thyroiditis is associated with thyroid lymphoma
HbA1C - recheck after 2-3 months
Hypercholesterolaemia rather than hypertriglyceridaemia: nephrotic syndrome, cholestasis,
hypothyroidism
In the primary prevention of CVD using statins aim for a reduction in non-HDL cholesterol of > 40%
Infertility in PCOS - clomifene is superior to metformin
Insulinoma is diagnosed with supervised prolonged fasting
Liddle's syndrome: hypokalaemia + hypertension
Meglitinides - stimulate insulin release - good for erratic lifestyle
Metformin should be titrated slowly, leave at least 1 week before increasing dose
Obesity - NICE bariatric referral cut-offs
with risk factors (T2DM, BP etc): > 35 kg/m^2
no risk factors: > 40 kg/m^2
Patients on insulin 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
Phaeochromocytoma: do 24 hr urinary metanephrines, not catecholamines
Polycystic ovarian syndrome - ovarian cysts are the most consistent feature
Small cell lung cancer accounts 50-75% of case of ectopic ACTH
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The diagnostic test for acromegaly is an oral glucose tolerance with growth hormone measurements
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
Thiazides cause hypercalcaemia
Thyrotoxicosis with tender goitre = subacute (De Quervain's) thyroiditis
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Gastroenterology
Wilson's disease - serum caeruloplasmin is decreased
24hr oesophageal pH monitoring is gold standard investigation in GORD
E. coli is the most common cause of travellers' diarrhoea
H. pylori eradication:
PPI + amoxicillin + clarithromycin, or
PPI + metronidazole + clarithromycin
Causes of villous atrophy (other than coeliacs): tropical sprue, Whipple's, lymphoma,
hypogammaglobulinaemia
Coeliac disease - tissue transglutaminase antibodies first-line test
Deterioration in patient with hepatitis B - ? hepatocellular carcinoma
17

Dysphagia affecting both solids and liquids from the start - think achalasia
Flucloxacillin + co-amoxiclav are well recognised causes of cholestasis
Gastric MALT lymphoma - eradicate H. pylori
Give 50% of normal energy intake in starved patients (> 5 days) to avoid refeeding syndrome
Hepatocellular carcinoma
hepatitis B most common cause worldwide
hepatitis C most common cause in Europe
Obese T2DM with abnormal LFTs - ? non-alcoholic fatty liver disease
Paracetamol overdose - high risk if chronic alcohol, HIV, anorexia or P450 inducers
Peutz-Jeghers syndrome - autosomal dominant
Primary biliary cirrhosis - the M rule
IgM
anti-Mitochondrial antibodies, M2 subtype
Middle aged females
Screening for haemochromatosis
general population: transferrin saturation > ferritin
family members: HFE genetic testing
The gold standard test for achalasia is oesophageal manometry
Ulcerative colitis - the rectum is the most common site affected
Urea breath test - no antibiotics in past 4 weeks, no antisecretory drugs (e.g. PPI) in past 2 weeks
Whipple's disease: jejunal biopsy shows deposition of macrophages containing Periodic acid-Schiff
(PAS) granules
Zollinger-Ellison syndrome: epigastric pain and diarrhoea
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Drug mechanism of action
Ondansetron - 5-HT3 antagonist
Inflammatory bowel disease: key differences

Notes1 / 2

Ulcerative colitis - primary sclerosing cholangitis

Notes0 / 1

Crohn's disease granulomas

Stereotypical histories (gastroenterology)

Notes0 / 1

A 45-year-old man is being investigated for diarrhoea, weight loss and

arthralgia. Jejunal biopsy shows deposition of macrophages containing
PAS-positive granules - Whipple's disease
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Notes1 / 2

A 30-year-old woman presents with foul smelling oily diarrhoea,

abdominal bloating, fatigue and weight loss. On examination she has
papulovesicular lesions on the extensor aspects of her arms - coeliac
disease
Stereotypical histories (hepatobiliary disorders)

Notes0 / 1

A 65-year-old man with a history of chronic hepatitis b infection

presents with symptoms and signs of liver cirrhosis. Alpha-fetoprotein is Notes0 / 1
elevated. - hepatocellular carcinoma
Stereotypical histories (upper gastrointestinal disorders)
A patient with a history of heartburn presents with odynophagia. There
no weight loss, vomiting or anorexia - oesophagitis

Notes0 / 1

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Infectious Diseases
Legionella pneumophilia is best diagnosed by the urinary antigen test
Chlamydia - treat with azithromycin or doxycycline
Chickenpox exposure in pregnancy - first step is to check antibodies
Genital ulcers
painful: herpes much more common than chancroid
painless: syphilis more common than lymphogranuloma venereum + granuloma
inguinale
Live attenuated vaccines
BCG
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 MMR
oral polio
yellow fever
oral typhoid
Schistosoma haematobium causes haematuria
Supportive therapy is the mainstay of treatment in Cryptosporidium diarrhoea
URTI symptoms + amoxicillin rash ?glandular fever
Antibiotic guidelines
Animal or human bite - co-amoxiclav
Bacteria: classification

Notes0 / 3

Neisseria meningitidis - Gram-negative cocci

Notes1 / 2

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Nephrology
Goodpasture's syndrome
IgG deposits on renal biopsy
anti-GBM antibodies

Neurology
'Fasciculations' - think motor neuron disease
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Chorea is caused by damage to the basal ganglia, in particular the Caudate nucleus
Dystrophia myotonica - DM1
distal weakness initially
autosomal dominant
diabetes
dysarthria
Absence seizures - good prognosis: 90-95% become seizure free in adolescence
Antiplatelets
TIA: clopidogrel
ischaemic stroke: clopidogrel
Asymmetrical symptoms suggests idiopathic Parkinson's
Bitemporal hemianopia
lesion of optic chiasm
upper quadrant defect > lower quadrant defect = inferior chiasmal compression, commonly a
pituitary tumour
lower quadrant defect > upper quadrant defect = superior chiasmal compression, commonly a
craniopharyngioma
Burning thigh pain - ? meralgia paraesthetica - lateral cutaneous nerve of thigh compression
CT head showing temporal lobe changes - think herpes simplex encephalitis
Cluster headache - acute treatment: subcutaneous sumatriptan + 100% O2
DVLA advice post CVA: cannot drive for 1 month
DVLA advice post multipler TIAs: cannot drive for 3 months
Eclampsia - give magnesium sulphate first-line
Epidural haematoma - lucid interval
Epilepsy + pregnancy = 5mg folic acid
Epilepsy medication: first-line
generalised seizure: sodium valproate
partial seizure: carbamazepine
Episodic eye pain, lacrimation, nasal stuffiness occurring daily - cluster headache
Essential tremor is an AD condition that is made worse when arms are outstretched, made better by
alcohol and propranolol
FVC is used to monitor respiratory function in Guillain-Barre syndrome
21

Fluctuating confusion/consciousness? - subdural haematoma

Fluctuating consciousness = subdural haemorrhage
Hemiballism is caused by damage to the subthalamic nucleus
Horner's syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast's, cervical rib
absent = post-ganglionic lesion: carotid artery
Hypertension should not be treated in the initial period following a stroke
Kearns-Sayre syndrome
mitochondrial inheritance
onset < 20-years-old
external ophthalmoplegia
retinitis pigmentosa
Lateral medullary syndrome - PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral
Horner's
Loss of corneal reflex - think acoustic neuroma
Medication overuse headache
simple analgesia + triptans: stop abruptly
opioid analgesia: withdraw gradually
Migraine
acute: triptan + NSAID or triptan + paracetamol
prophylaxis: topiramate or propranolol
Miller Fisher syndrome - areflexia, ataxia, ophthalmoplegia
Motor neuron disease - riluzole
Motor neuron disease - treatment: NIV is better than riluzole
Neuroimaging is required to diagnose dementia
Nitrofurantoin may cause peripheral neuropathy
Obese, young female with headaches / blurred vision think idiopathic intracranial hypertension
Painful third nerve palsy = posterior communicating artery aneurysm
Patients cannot drive for 6 months following a seizure
Progressive supranuclear palsy: parkinsonism, impairment of vertical gaze
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Prolactinoma management - medical therapy is almost always first-line

Ptosis + dilated pupil = third nerve palsy; ptosis + constricted pupil = Horner's
Restless leg syndrome - management includes dopamine agonists such as ropinirole
Ropinirole - dopamine receptor agonist
Stroke thrombolysis - only consider if less than 4.5 hours and haemorrhage excluded
Syringomyelia - spinothalamic sensory loss (pain and temperature)
Trigeminal neuralgia - carbamazepine is first-line
Urinary incontinence + gait abnormality + dementia = normal pressure hydrocephalus
V for Vigabatrin - V for Visual field defects
Visual field defects:
left homonymous hemianopia means visual field 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
Wilson's disease - autosomal recessive
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Brain anatomy
Frontal lobe lesions may cause perseveration
Stereotypical histories (neurological disorders)

Notes1 / 3

A 55-year-old presents with fever, headache, confusion and aphasia. A

CT shows petechial haemorrhages in the temporal lobe - herpes simplex Notes2 / 4
encephalitis
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Ophthalmology
Drusen = Dry macular degeneration
Acute angle closure glaucoma is associated with hypermetropia, where as primary open-angle
glaucoma is associated with myopia
Central retinal vein occlusion - sudden painless loss of vision, severe retinal haemorrhages on
fundoscopy
Flashes and floaters - vitreous/retinal detachment
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Holmes ADIe = DIlated pupil, females, absent leg reflexes

Horner's syndrome - anhydrosis determines site of lesion:
head, arm, trunk = central lesion: stroke, syringomyelia
just face = pre-ganglionic lesion: Pancoast's, cervical rib
absent = post-ganglionic lesion: carotid artery
Macular degeneration - smoking is risk factor
Red eye - glaucoma or uveitis?
glaucoma: severe pain, haloes, 'semi-dilated' pupil
uveitis: small, fixed oval pupil, ciliary flush
Retinitis pigmentosa - night blindness + funnel vision
Scleritis is painful, episcleritis is not painful
Treatment of acute glaucoma - acetazolamide + pilocarpine
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Psychiatry
Alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
Anorexia features
most things low
G's and C's raised: growth hormone, glucose,
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salivary glands, cortisol,cholesterol, carotinaemia

Antipsychotics in the elderly - increased risk of stroke and VTE
Atypical antipsychotics commonly cause weight gain
Clozapine is no longer used first-line due to the risk of agranulocytosis
Dosulepin - avoid as dangerous in overdose
Lofepramine - the safest TCA in overdosage
Parkinson's disease - most common psychiatric problem is depression
Paroxetine - higher incidence of discontinuation symptoms
Post-natal depression is seen in around 10% of women
SSRI + NSAID = GI bleeding risk - give a PPI
Unexplained symptoms
Somatisation = Symptoms
hypoChondria = Cancer
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Respiratory Medicine
Streptococcus pneumoniae is associated with cold sores
Saccharopolyspora rectivirgula causes farmer's lung, a type of EAA
Alpha-1 antitrypsin deficiency - autosomal recessive / co-dominant
Aspergillus clavatus causes malt workers' lung, a type of EAA
Asthma - intermediate probability - do spirometry first-line
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Asthma diagnosis - if high probability of asthma - start treatment

Bronchiectasis: most common organism = Haemophilus influenzae
COPD - LTOT if 2 measurements of pO2 < 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
CTPA is the first line investigation for PE according to current BTS guidelines
Contraindications to lung cancer surgery include SVC obstruction, FEV < 1.5, MALIGNANT pleural
effusion, and vocal cord paralysis
Erythema nodosum is associated with a good prognosis in sarcoidosis
Flow volume loop is the investigation of choice for upper airway compression
Isocyanates are the most common cause of occupational asthma
Lung adenocarcinoma
most common type in non-smokers
peripheral lesion
Massive PE + hypotension thrombolyse
Mycoplasma pneumonia if allergic/intolerant to macrolides - doxycycline
Mycoplasma? - serology is diagnostic
Paraneoplastic features of lung cancer
squamous cell: PTHrp, clubbing, HPOA
small cell: ADH, ACTH, Lambert-Eaton syndrome
Pneumocystis jiroveci pneumonia - pneumothorax is a common complication
Pneumonia in an alcoholic Klebsiella
Preceding influenza predisposes to Staphylococcus aureus pneumonia
Pulmonary embolism - CTPA is first-line investigation
Pulmonary embolism - normal CXR
Sarcoidosis CXR
1 = BHL
2 = BHL + infiltrates
3 = infiltrates
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 4 = fibrosis
Serial peak flow measurements at work and at home are used to detect occupational asthma
Sleep apnoea causes include obesity and macroglossia
Symptom control in non-CF bronchiectasis - inspiratory muscle training + postural drainage
The majority of patients with sarcoidosis get better without treatment
Transfer factor
raised: asthma, haemorrhage, left-to-right shunts, polycythaemia
low: everything else
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Rheumatology
Ankylosing spondylitis - x-ray findings: subchondral erosions, sclerosis
and squaring of lumbar vertebrae
Ankylosing spondylitis features - the 'A's
Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
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 AV node block
Amyloidosis
Anti-Jo-1 antibodies are more common in polymyositis than dermatomyositis
Anti-cyclic citrullinated peptide antibodies are associated with rheumatoid arthritis
Anti-ribonuclear protein (anti-RNP) = mixed connective tissue disease
Antiphospholipid syndrome: arterial/venous thrombosis, miscarriage, livedo reticularis
Azathioprine - check thiopurine methyltransferase deficiency (TPMT) before treatment
Dermatomyositis antibodies: ANA most common, anti-Mi-2 most specific
Gout: start allopurinol if >= 2 attacks in 12 month period
Lateral epicondylitis: worse on resisted wrist extension/suppination whilst elbow extended
Limited (central) systemic sclerosis = anti-centromere antibodies
NICE recommend co-prescribing a PPI with NSAIDs in all patients with osteoarthritis
Oral ulcers + genital ulcers + anterior uveitis = Behcet's
Osteoarthritis - paracetamol + topical NSAIDs (if knee/hand) first-line
Osteoporosis in a man - check testosterone
Paget's disease - old man, bone pain, raised ALP
Pseudogout - positively birefringent rhomboid shaped crystals
Raynaud's disease (i.e. primary) presents in young women with bilateral symptoms
Rheumatoid arthritis - TNF is key in pathophysiology
Rheumatoid arthritis: patients have an increased risk of IHD
SLE - antibodies associated with congenital heart block = anti-Ro
SLE: ANA is 99% sensitive - anti-Sm & anti-dsDNA are 99% specific
SLE: C3 & C4 low
Scleritis is painful, episcleritis is not painful
Septic arthritis - most common organism: Staphylococcus aureus
The vast majority of gout is due to decreased renal excretion of uric acid
Urethritis + arthritis + conjunctivitis = reactive arthritis
cANCA = Wegener's; pANCA = Churg-Strauss + others
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