1. Acromegaly Diagnosis: OGTT followed by GH concentration.

2. Cushings Diagnosis: 24hr urinary free cortisol. Addisons > short

synacthen.
3. Rash on Buttocks Dermatitis herpetiformis (coeliac dx).
4. AF with TIA > Warfarin. Just TIAs with no AF > Aspirin
5. Herpes Encephalitis > temporal lobe calcification OR
temporoparietal attenuation subacute onset i.e. Several days.
6. Obese woman, papilloedema/headache > Intracranialrcanial
Hypertention.
7. Drug induced pneumonitis > methotrexate or amiodarone.
8. Chest Discomfort and Dysphagia > achalasia.
9. Foreign Travel, macpap rash/flu like illnes > HIV acute.
10. Cause of Gout > dec urinary excretion.
11. Bullae on the hands and fragule SKIN torn by minor
trauma > porphyria cutanea tarda.
12. Splenectomy > need pneumococcal vaccine AT LEAST 2
weeks pre-op and for life.
13. Primary Hyperparathyroidism > high Ca, normal/low PO4,
normal/high PTH (in elderly).
14. Middle aged man with KNEE arthritis > gonococcal sepsis
(older people -> Staph).
15. Sarcoidosis, Erythema Nodosum, Arthropathy > Loffgrens
syndrome benign, no Rx needed.
16. TREMOR postural, slow progression, titubation, relieved
by OH->benign essential TREMOR AutDom. (MS titbation, PD no
titubation)
17. Electrolytes disturbance causing confusion low/high Na.
18. Contraindications lung Surgery > FEV dec bp 130/90, Ace
inhibitors (if proteinuria analgesic induced headache.
19. 1.5 cm difference between kidneys -> Renal artery stenosis
> Magnetic resonance angiogram.
20. Temporal Tenderness> temporal arteritis -> steroids > 90%
ischaemic neuropathy, 10% retinal art occlusion.
21. Severe retroorbital, daily headache, lacrimation > cluster
headache.
22. Pemphigus involves mouth (mucus membranes), pemphigoid
less serious NOT mucosa.
23. Diagnosis of Polyuria -> water deprivation test, then DDAVP.
24. Insulinoma -> 24 hr supervised fasting hypoglycaemia.
25. Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen
in HCT.
26. Causes of villous atrophy: coeliac (lymphocytic infiltrate),
Whipples , dec Ig, lymphoma, trop sprue (rx tetracycline).
27. Diarrhea, bronchospasm, flushing, tricuspid stenosis ->
gut carcinoid c liver mets.
28. Hepatitis B with general deterioration -> hepaocellular
carcinoma.
29. Albumin normal, total protein high -> myeloma
(hypercalcaemia, electrophoresis).
30. HBSag positive, HB DNA not detectable > chornic carier.
31. M.I, artery involved -> Right coronary artert.
32. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP,
FAMILIAL hyperchol,Gilberts, Huntingtons, Marfanss, NFT I/II, Most
porphyrias, tuberous sclerosis, vWD, PeutzJeghers.
33. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD,
Haemophilia A/B.
34. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS,
MR.
35. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap:
MOBILE MS, severe near S2.
36. HOCM/MVP inc by standing, dec by squating (inc all others).
HOCM inc by valsalva, decs all others. Sudden death athlete, FH,
Rx. Amiodarone, ICD.
37. MVP sudden worsening post MI. Harsh systolic murmur
radites to axilla.
38. Dilated Cardiomyopathy: OH, bp, thiamine/selenium
deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT,
sarcoid), tachycardia.
39. Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid,
HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia
Lofflers, caracinoid, malignancy, radiotherapy, toxins.
40. Tumor compressing Respiratory tract > investigation: flow
volume loop.
41. Guillan Barre syndrome: check VITAL CAPACITY.
42. Horners sweating lost in upper face only lesion proximal to
common carotid artery.
43. Internuclear opthalmoplegia: medial longitudinal fasciculus
connects CN nucleus 3-4. Ipsilateral adduction palsy, contralateral
nystagmus. Aide memoire (TRIES TO YANK THE ipsilateral BAD eye
ACROSS THE nose ). Convergence retraction nystagmus, but
convergence reflex is normal. Causes: MS, SLE, Miller fisher,
overdose(barb, phenytoin, TCA), Wernicke.
44. Progressive Supranuclear palsy: Steel Richardson. Absent
voluntary downward gaze, normal dolls eye . i.e. Occulomotor nuclei
intact, supranuclear Pathology .
45. Perinauds syndrome: dorsal midbrain syndrome, damaged
midrain and superior colliculus: impaired upgaze (cf PSNP), lid
retraction, convergence preserved. Causes: pineal tumor, stroke,
hydrocephalus, MS.
46. Dementia, gait abnormaily, urinary incontinence. Absent
papilloedema>Normal pressure hydrocephalus.
47. Acute red eye -> acute closed angle glaucoma >> less
common (ant uveitis, scleritis, episcleritis, subconjuntival
haemmorrhage).
48. Wheeles, URTICARIA , drug induced -> aspirin.
49. Sweats and weight gain -> insulinoma.
50. Diagnostic test for asthma -> morning dip in PEFR >20%.
51. Causes of SIADH : chest/cerebral/pancreas Pathology ,
porphyria, malignancy, Drugs (carbamazepine, chlorpropamide,
clofibrate, atipsychotics, NSAIDs, rifampicin, opiates)
52. Causes of Diabetes Insipidus: Cranial: tumor, infiltration,
trauma Nephrogenic: Lithium, amphoteracin, domeclocycline,
prologed hypercalcaemia/hypornatraemia, FAMILIAL X linked type
53. Bisphosphonates: Inhibit osteoclast activity, prevent steroid
incduced osteoperosis (vitamin D also).
54. Returned from airline flight, TIA-> paradoxical embolus do
TOE.
55. Alcoholic, given glucose develops nystagmus -> B1
deficiency (wernickes). Confabulation->korsakoff.
56. Mono-artropathy with thiazide -> gout (neg birefringence).
NO ALLOPURINOL for acute.
57. Painful 3rd nerve Palsy -> posterior communicating artery
aneurysm till proven otherwise
58. Late complication of scleroderma > pulmonary
hypertension plus/minus fibrosis.
59. Causes of erythema mutliforme: lamotrigine
60. Vomiting, abdominal pain, hypothyroidism -> Addisonian
crisis (TFT typically abnormal in this setting DO NOT give thyroxine).
61. Mouth/genital ulcers and oligarthritis -> behcets (also eye
/SKIN lesions, DVT)
62. mixed drug overdose most important step -> Nacetylcysteine
(time dependent prognosis)
63. Cavernous sinus syndrome 3rd nerve palsy, proptosis,
periorbital swlling, conj injectn
64. Asymmetric Parkinsons -> likely to be idiopathic
65. Obese, NIDDM female with abnormal LFTs -> NASH (non-
alcoholic steatotic hepatitis)
66. Fluctuating level of conciousness in elderly plus/minus
deterioration > chronic subdural. Can last even longer than 6
months
67. Sensitivity > TP/(TP plus FN) e.g. For SLE ANA highly sens,
dsDNA:highly specific
68. RR is 8%. NNT is -> 100/8 > 50/4 > 25/2 > 13.5
69. Ipsilateral ataxia, Horners, contralateral loss
pain/temp > PICA stroke (lateral medulary syndrome of
Wallenburg)
70. Renal stones (80% calcium, 10% uric acid, 5%
ammonium (proteus), 3% other). Uric acid and cyteine stone
are radioluscent.
71. Hyperprolactinaemia (allactorrohea, amenorrohea, low
FSH/LH) -> Da antags (metoclopramide, chlorpromazine, cimetidine
NOT TCAs), pregnancy, PCOS, pit tumor/microadenoma, stress.
72. Distal, asymetric arthropathy -> PSORIASIS
73. An episodic headache with tachycardia ->
phaeochromocytoma
74. Very raised WCC -> ALWAYS think of leukaemia.
75. Diagnosis of CLL > immunophenotyping NOT cytogenetics,
NOT bone marrow
76. Prognostic factors for AML -> bm karyotype
(good/poor/standard) >> WCC at diagnosis.
77. Pancytopenia with raised MCV > check B12/folate first
(other causes possble, but do this FIRST). Often associayed with
phenytoin use > decreased folate
78. Miscarriage, DVT, stroke > LUPUS anticoagulant > lifelong
anticoagulation
79. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
80. Anosmia, delayed puberty -> Kallmans syndrome
(hypogonadotrophic hypogonadism)
81. Diagnosis of PKD -> renal US even if think anorexia nervosa
82. Commonest finding in G6PD hamolysis -> haumoglobinuria
83. Mitral stenosis: loud S1 (soft s1 if severe), opening snap..
Immobile valve -> no snap.
84. Flank pain, urinalysis: blood, protein -> renal vein
thrombosis. Causes: nephrotic syndrome, RCC, amyloid, acute
pyelonephritis, SLE (atiphospholipid syndrome which is recurrent
thrombosis, fetal loss, dec plt. Usual cause of cns manifestations
assoc with LUPUS ancoagulant, anticardiolipin ab)
85. Anemia in the elderly assume GI malignancy
86. Hypothermia, acute renal failure -> rhabdomyolysis (collapse
assumed)
87. Pain, numbness lateral upper thigh > meralgia
paraesthesia (lat cutaneous nerve compression usally by by ing
ligament)
88. Diagnosis of haemochromatosis: screen with Ferritin, confirm
by tranferrin saturation, genotyping. If nondiagnostic do liver biopsy
0.3% mortality
89. 40 mg hidrocortisone divided doses (bd) > 10 mg
prednisolone (ie. Prednislone is x4 stronger)
90. BTS: TB guidlines close contacts -> Heaf test -> positive CXR,
negative > repeat Heaf in 6 weeks. Isolation not required
91. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio
and neuro toxicity.
92. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis
over hair follicles ->>Discoid LUPUS
93. Weight loss, malabsoption, increase ALP -> pancreatic
cancer
94. Foreign travel, tender RUQ, raised ALP > liver abscess do
U/S
95. Weight loss, anaemia (macro/micro), no obvious cause ->
coeliac (diarrhoea does NOT have to be present)
96. Haematuria, proteinuria, best investigation > if
glomerulonephritis suspected > renal biopsy
97. Venous ulcer treatment > exclude arteriopathy (eg ABPI),
control oedema, prevent infection, compression bandaging.
98. Malaria, incubation within 3/12. can be relapsing
/remitting. Vivax and Ovale (West Africa) longer imcubation.
99. Fever, lymphadenopathy, lymphocytosis,
pharygitis >EBV > heterophile antibodies
100. GI bleed after endovascular AAA Surgery > aortoenteric
fistula