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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PR depression pericarditis
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Hypertension levels
Blood pressure target (< 80 years, clinic reading) - 140/90 mmHg
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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
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Clinical Pharmacology
Drug adverse effects
Amiodarone may cause hyperthyroidism
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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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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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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
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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
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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
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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
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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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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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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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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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