1. Acromegaly – Diagnosis: OGTT followed by GH conc.
2. Cushings – Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen.
3. Rash on buttocks – Dermatitis herpetiformis (coeliac dx).
4. AF with TIA --> Warfarin. Just TIA's with no AF --> Aspirin
5. Herpes encephalitis --> temporal lobe calicification OR temporoparietal attentuation – subacute onset i.e. Several days.
6. Obese woman, papilloedema/headache --> Benign Intercanial 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 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 hrperparathyroidism --> 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.
21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance angiogram.
22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion.
23. severe retroorbital, daily headache, lacrimation --> cluster headache.
24. pemphigus – involves mouth (mucus membranes), pemphigoid – less serious NOT mucosa.
25. diagnosis of polyuria -> water deprivation test, then DDAVP.
26. insulinoma -> 24 hr supervised fasting hypoglycaemia.
27. Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT.
28. causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig, lymphoma, trop sprue (rx tetracycline).
29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets.
30. hepatitis B with general deterioration -> hepaocellular carcinoma.
31. albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis).
32. HBSag positive, HB DNA not detectable --> chornic carier.
33. Inf MI, artery invlived -> Right coronary artert.
34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, FAMILIAL hyperchol,Gilberts, Huntington's, Marfans's, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers.
35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B.
36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR.
37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2.
38. 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.
39. MVP sudden worsening post MI. Harsh systolic murmur radites to axilla.
40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia.
41. Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy, radiotherapy, toxins.
42. Tumor compressing Respiratory tract --> investigation: flow volume loop.
43. Guillan Barre syndrome: check VITAL CAPACITY.
44. Horners – sweating lost in upper face only – lesion proximal to common carotid artery.
45. 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.
46. Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal dolls eye . i.e. Occulomotor nuclei intact, supranuclear Pathology .
47. Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS.
48. demetia, gait abnormaily, urinary incontinence. Absent papilloedema-->Normal pressure hydrocephalus.
49. acute red eye -> acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcleritis, subconjuntival haemmorrhage).
50. wheeles, URTICARIA , drug induced -> aspirin.
51. sweats and weight gain -> insulinoma.
52. diagnostic test for asthma -> morning dip in PEFR >20%.
53. Causes of SIADH : chest/cerebral/pancreas Pathology , porphyria, malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs, rifampicin, opiates)
54. Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma Nephrogenic: Lithium, amphoteracin, domeclocycline, prologed hypercalcaemia/hypornatraemia, FAMILIAL X linked type
55. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vitamin D also).
56.returned from airline flight, TIA-> paradoxical embolus do TOE.
57. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff.
58. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute.
59. painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven otherwise
60 late complication of scleroderma --> pumonaryhypertention plus/minus fibrosis.
61. causes of erythema mutliforme: lamotrigine
62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically abnormal in this setting DO NOT give thyroxine).
63. mouth/genital ulcers and oligarthritis -> behcets (also eye /SKIN lesions, DVT)
64. mixed drug overdose most important step -> Nacetylcysteine (time dependent prognosis)
65. cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling, conj injectn
66. asymetric parkinsons -> likely to be idiopathic
67. Obese, NIDDM female with abnormal LFT's -> NASH (non-alcoholic steatotic hepatitis)
68. fluctuating level of conciousness in elderly plus/minus deterioration --> chronic subdural. Can last even longer than 6 months
69. Sensitivity --> TP/(TP plus FN) e.g. For SLE - ANA highly sens, dsDNA:highly specific
70. RR is 8%. NNT is ----> 100/8 --> 50/4 --> 25/2 --> 13.5
71. ipsilateral ataxia, Horners, contralateral loss pain/temp --> PICA stroke (lateral medulary syndrome of Wallenburg)
72. renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric acid and cyteine stone are radioluscent.
73. hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Da antags (metoclopramide, chlorpromazine, cimetidine NOT TCA's), pregnancy, PCOS, pit tumor/microadenoma, stress.
74. Distal, asymetric arthropathy -> PSORIASIS
75. episodic headache with tachycardia -> phaeochromocytoma
76. very raised WCC -> ALWAYS think of leukaemia.
77. Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT bone marrow
78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at diagnosis.
79. pancytopenia with raised MCV --> check B12/folate first (other causes possble, but do this FIRST). Often associayed with phenytoin use --> decreased folate
80. miscariage, DVT, stroke --> LUPUS anticoagulant --> lifelong anticoagulation
81. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
82. anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic hypogonadism)
83. diag of PKD -> renal US even if think anorexia nervosa
85. commonest finding in G6PD hamolysis -> haumoglobinuria
86. mitral stenosis: loud S1 (soft s1 if severe), opening snap.. Immobile valve -> no snap.
87. 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)
88. anaemia in the elderly assume GI malignancy
89. hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)
90. pain, numbness lateral upper thigh --> meralgia paraesthesia (lat cutaneous nerve compression usally by by ing ligament)
91. diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrin saturation, genotyping. If nondiagnostic do liver biopsy 0.3% mortality
92. 40 mg hidrocortisone divided doses (bd) --> 10 mg prednisolone (ie. Prednislone is x4 stronger)
93. BTS: TB guidlines – close contacts -> Heaf test -> positive CXR, negative --> repeat Heaf in 6 weeks. Isolation not required.
94. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity.
95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles ->>Discoid LUPUS
96. wt loss, malabsoption, inc ALP -> pancreatic cancer
97. foreign travel, tender RUQ, raised ALP --> liver abscess do U/S
98. wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoea does NOT have to be present)
99. haematuria, proteinuria, best investigation --> if glomerulonephritis suspected --> renal biopsy
100. venous ulcer treatment --> exclude arteriopathy (eg ABPI), control oedema, prevent infection, compression bandaging.
101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West Africa) longer imcubation.
102. Fever, lymphadenopathy, lymphocytosis, pharygitis --->EBV ---> heterophile antibodies
103. GI bleed after endovascular AAA Surgery --> aortoenteric fistula
104. Young girl – suspect Anorexia Nervosa – linugo hair, finctional hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually normal. Ferritin low.
105. Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Yersinia, SALMONELLA , Shigella. Balanisits.
106. PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
107. Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis
108. heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
109. Vitiligo – commonest assoctions pernicious anaemia >>> type 1 DM , autoimmune addisons, autoimmune thyoid dx
110. Gout – blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute phase
111. Peripheral neuropathy – a) B12 – rapid, dorsal columns (joint pos, vibration), sensory ataxia, pseudoathetosis of upperlimbs b) diabetic – slow, spinothalamic (pain, temp?) c)alcohol – slow progressive, spinothalamic d) Pb – motor upper limbs
112. CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML – demylination in advanced HIV, low attenuation lesions)
113. Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), SALMONELLA (serious systemic illness), E.coli (rx. Ciprofloxacin) , Shigella
114. Renal syndrome – minimal change disease, membanous, IgA nephropathy, post-streptococcal.
115. If you see blood on urinalysis forget about RAS
116. Thyroid Malignancy – tend to be non-functional, anaplastic has worse prognosis, local infiltration -> dysphagia, vocal cord paralysis
117.ALMOST Pathognomic for the exam
fatiguability -> myasthenia gravis
fasciculations -> Motor neurone diease
silvery white scale -> PSORIASIS
hypopigmented -> vitiligo/pityriasis versicolor
pretibial myxoedema --> Graves (NOT lid lag, NOT exopthalmus)
