Beruflich Dokumente
Kultur Dokumente
Exam (UK)
Author: sujitvasanth, Posted on Wednesday, November 23 @ 19:29:36 IST by RxPG
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1. Renal deterioration is most often due to NSAID's: NSAID' --> renal deterioration, ATN,
interstitial nephritis, renal papillary necrosis, chronic tubulo interstitial nephritis. If asked
most LIKELY cause of renal failure NSAIDs are likely to be the answer.
3. diabetic patient maximum reduction in CVS risk bp (esp ACE i >>> tight glycaemic
control, weight reduction unproven.
4. antipsychotic + fever, rigidity, confusion, ANS dysfunction --> NMS. can be pptd by
anticholinergics, lithium and benztropine. Rx. withdraw agent, antipyretics, dantrolene,
bromocriptine, levodopa. Can occur at any time since starting antipsychotics.
6.blood gases: Normal values: pH 7.36-7.44, O2 11.3-12.6, co2 4.7-6.0, hc03 20-28
interpretation rules:
i) pH defines primary disturbance
ii) pO2, pCO2: can be type 1/type 2 resp failure or hypreventilation
iii) hco3: metabolic component
iv) consider lab error if pH is not proportional to HC03:Co2 ratio.
v) anion gap in poisoning (methanol, ethylene glycol), ketoacidosis
trap: alkal, hi HCO3, tp1 failure->should be tp2 if compnstry->mixed metalk+resp acd
7.carbimazole and sore throat --> if WCC normal and neutrophils OK then reassure and
continue. rate of leuco/neutropenia is only 1%. Stop if neut stop carbimazole, give
antibiotics, consider GCSF
9.trivial trauma in young people --> stroke...think vertebral artery dissection. head and
neck pain + stroke --> think of dissection. usually under 40 yrs, trivial trauma with some
neck distrotion.stroke is often brainstem/cerebeller.
13.legionella pneumonia (systemic upset, non porductive cough, inc wcc, lympohopenia,
low Na--> Rx. azithromycin or levofloxacin. Legionaires disease --> flu-like prodrome,
fever, non-productive cough, confusion, neutrophilia, lymphopenia, HYPONATRAEMIA,
non specific liver derangement, proteinuria/myoglobinurua, lobar or bilateral
consolidation, macrolides (azithromycin) or quinolones (levofloxacin) (both superior to
erythromycin). combination therapy of erythromycin and rifampicin is second line.
doxycyclline, cotramoxazole and tetracycline can also be used.
15.foreign travel (esp Africa businessman), rash, lyphadenopathy -> HIV conversion
illness
16.>1g/day proteinuria before ANY other treatment ---> ACE inhibitor. indications for
ACEi in renal failure: hypertension -->and/or>> glycaemic control. Antibiotics not to be
given prophylactically in this case. Low protein diet beficifal in overt proteinuria not
microabluminurea.
17.CRF + Fe PO + anaemia --> give Fe iv to replenish stores PLUS EPO. keep Hb >11 to
prevent LVH. If patient symptomatic i.e. angina then transfuse.
18.obese female, headache, papilloedema --> BIH --> Rx is peritoneal shunt. Benign
intercranial hypertension -- obese lady, pappilloedema, headaches worse in morning. 1.
CT to exclude SOL. 2. LP. 3. MRI venogram to exclude venous thrombosis, Space
occupying lesion, hydrocephalus (better than CT). causes of BIH --> vitamin A,
tetracycline, OCP
20.coeliac disease --> IgA deficiency, dec Ca, Fe anaemia, aphous ulcers, antiendomesial
IgA may be negative--> test transglutaminase IgG. hypocalcaemia is seen in Coeliac
disease. hypocalcaemia, iron deficiency anaemia, normal inflammatory markers, GI
symptoms --> coeliac disease. raised MCV --> tropical sprue.
23. DM , impotence, normal LFT --> 1. MRI pituitry (pituitry tumor compressing stalk).
2. abnormal LFT ---> check ferritin (Haemochromatosis)
24.erythema nodusum --> need CXR to exclude sarcoid/TB. erythema nodosum: sarcoid,
TB (NB. ALWAYS first do CXR), infection (strep), drugs (sulphonamides, OCP),
inflamatory bowel disease, behcets disease. Lesions last 6-8 weeks. other tests: asot
titre, throat swab, Mantoux test. Rx underlying cause, NSAIDs, bed rest. not associated
with DM or PSORIASIS .
25.catheters pressures/sats: Left side of heart : LA, LV, Aorta are all 98%. Right Side
heart : RA, RV, Pulm A all 74%, (IVC 70%, SVC 74%). Mean pressures (mmHg). PA 10,
Aorta 100, PCWP 1-10. From this info you can calculate where is the lesion.
26.Guillan Barre syndrome - lower back pain, unconfirmed subjective sensory symptoms
(e.g. tingling), CN lesions, absent reflexes, motor weakness, preceding resp illness
27.adverse risks with aortic stenosis ---> symptomatic LV failure, EF Rx. Oxygen or sc
sumitriptan. prophylaxis: verapamil, Lithium or valproate. cf.. mirgaine propranolol cf.
Trigeminal neuralgia --> carbamazepine
33. new hypertensive guidelines: 55yrs/black (Ca antag or Diuretic) as first line. If
hypertension in urinary incontinance --> Ca ch blocker NOT alpha blocker. isolated
systolic hypertension in elderly --> thiazides or Ca antagonists. with diastolic
hypertension --> ACEi (????not sure about this)
36.total t3/4 up, TSH and free t3/4 normal ---> pregnancy. Compare this with:- normal
T3/4, raised TSH --> non compliance – e.g. patient took thyoxine just before clinic
appointment!
37.CN 10, 11, 12 palsy, pulsatile tinnitus ---> glomus jugulare tumor
38.smoker, proximal muscle weakness, dry mouth --> Eaton Lambert syndrome. Eaton
Lambert - dec reflexes, proximal weakness, ANS dysfunction.
39. Schmitt's disease: autoimmune diabetes and Addison's which can be associated with
primary ovarian failure and primary hypothyroidism. In this combination think of
Schmitt's before pituitry dysfunction.
40.AF: flecainide contraindicated in ischaemic heart disease. sotalol can be used for PAF
to maintain sinus rythm. Adenosine (used in SVT) contraindicated in asthma.
41.preg: raised oestrodiol, anorexia - mildly elevated prolactin, ammenorrhea. low BMI,
hyperprolatinaemia, excessive exercise --> anorexia nervosa. (prolactin not raised in
coeliac disease).
42.endocrine abnormalities:
1. PCOS - ostradiol normal, inc LH:FSH ratio, mildly inc prolactin and androgens.
Obesity, huruitism, oligomennorhea.
2. CAH --> elevated 17-hydroxyprogesterone
3. adrenal testostrn tumor--> testosterone >7, switches off LH/FSH --> low oestrgens
4. preg --> v high osetrgn and progestrn, normal testostrn. inc TotT4 normal freT4
43.entrapment palsies: common peroneal --> lost dorsiflexion and eversion, ulnar nerve
at elbow. Especially after prolonged bedrest.
47.pacemakers: exertional problems or a patient who is fit and active --> always better
to give a rate dependent pacemaker .eg XXX-R
48.hyperthyroidism: -
1.DeQuevern's thyroiditis: tender thyroid, wt loss, malaise, fever, ESR >50 or 100.
2.solitary toxic nodule commonest cause
3.thyroid autoantibodies: think of Grave's or Hashitoxicosis. If these absent solitary
thyroid nodule is likely. Drug induced typically is amiodarone.
4.transient post partum thyrotoxicois lasts 2-6months, occurs in 5% of women
5.pregnancy with hyperthyroidism --> carbimazole NOT radioidine, NOT thyroxine plus
carmbimazole. Surgery increases risk of miscarriage.
6.thyroid disease on OCP --> check free T4 to exclude hyperproteinaemia falsely
elevating T4 and TSH. raised ALP is likely due to thyrotixcoisis.
49.gut carcinoid: diarrhoea, flushing, wheeze, valvular heart disease, raised 5HIAA.
worse prognosis is with cardiac lesions (irrevesible and often require Surgery )
50.decreasing insulin requirements in diabetic, hypos, wt loss and lethargy --> consider
Addisson's.
51.child with hyperkalaemia, metabolic alkalosis and normal blood pressure ---> Barters
syndrome (polyuric enuesis, failure to thrive assoc hyperplasia of JGA). hypokalaemic
alkalosis --> vomiting e.g. pyloric stenosis
53.AML:- M2 t(8;21), M4 t(16;16), M3 t(15;17) promyelocytic assoc DIC, Rx. All trans
retinoic acid, Auer rods. acute promyelocytic leukaemia t(15;17) DIC, Rx: all trans
retinoic acid (ATRA). Auer rods.
55.patient looking tired --> think myasthenia gravis, ask to count to 100.
56.culture negative Bacterial endocarditis --> take 4 cultures at any time before
empiricle treatment with benzylpenicillin and gentamycin
57.hyperkalaemia in heart failure: step 1: monitor, step 2: add a K loosing diuretic step
3: consider stopping amiloride/spirinolactone
Please feel free to suggest corrections/additions to the list. I would remind you to only
give facts THAT HAVE APPEARED REPEATEDLY ON PAST PAPERS OF MRCP PART2.
Dr Sujit Vasanth