MRCP revision

• 1. Saccharopolyspora Rectivirgula
• 2. Aspergillus Clavatus
• 3. Avian Protiens found in aerosolised faeces
• 4. Thermophillic Actinomyces

Purple, Pruritic, Papular, polygonal rash on flexor surfaces

Itchy white spots on the vulva of old ladies

• 1. EN - Symmetrical Tender nodules which heal without scarring. Causes = Strep infection, IBD, Sarcoid, Drugs (Penicillin, Sulphonamides, OCP)
• 2. Symmetrical, erythematous, shiny, orange-peel skin. Causes = Graves
• 3. PG - Initially small papulepustule with red halo then deep red necrotic ulcer with violaceous border. Causes = 50%idiopathic, IBD, myeloproliferative and connective tissue disorders
• 4. Shiny, painless area of yellow red skin. Assoc telangectasia. Causes = diabetes

• Codiene x 2 = tramadol
• Tramadol x 5 = Oromorph
• Oromorph x 2 = oxycodone
• Oromorph x 3 = subcut diamorph

• Nsaids
• Radiotherapy

• 2 days: Catheter ablation for arrythmia
• 1week: Elective angioplasty, Pacemaker insertion
• 4 weeks: ACS, CABG, Prophylactic ICD insertion
• 6 months: Sustained ventricular arrythmia
• Aortic aneurysms: Inform DVLA. Not allowed to drive if aneurysm >6.5cm
• Heart transplant - No restrictions!!!!

• Chromosome 6
• ABC=class 1, DPDQDR=class 2
• HLA-A3=Haemochromotosis
• HLA-B5=Behcet's
• HLA-B27=Ankspond, Reiter's, Acute anterior uveitis
• HLA-DQ2DQ8=Coeliacs
• HLA-DR2=Narcolepsy, goodpasture's
• HLA-DR3=Dermatitis herpetiformis, Sjogren's, PBC
• HLA-DR4= T1DM, RA

Malignant proliferation of lymphocytes, characterised by the Reed-Sternberg cell. Spreads in an orderly fashion from lymph node to lymph node. Peaks between 15-35 and at 55.

• Wt loss >10%
• Night sweats 
• Fever >38
• Imply a worse prognosis.

• Classified based on Reed-Sternberg morphology and the reactive cell inflitrate.
• Nodular Sclerosing - Most common (70%), More common in females, good prognosis.
• Mixed Cellularity - 20% of all hodgkins lymphoma, good prognosis
• Lymphocyte predominant - 5%, best prognosis
• Lymphocyte deplete - Rare, worst prognosis.

• Somatisation = SYMPTOMS, persistent symptoms for >2yrs, refusal to accept reassurancenegative results
• Hypochondria = DISEASE, persistent belief of serious underlying diagnosis. Again refusal to believe proof.
• Conversion = Loss of motorsensory function. Patient does not consciously feign sx or seek material gain.
• Malingering = Exaggerationsimulation of symptoms for financial or other gain.
• Munchausen's - Intentional production of ACTUAL symptoms eg poisoningself harming
• Dissociative disorder = Seperating of certain memories from conscious stream eg stuporfugueamnesia. In sever forms can cause multiple personality disorder.

• Sensory inattention
• Apraxias
• Asterognosis (tactile agnosia)
• Inferior homonymous quadrantanopia
• When in the dominant lobe, Gerstmann's Syndrome = alexia, acalculia, finger agnosia, right-left disorientation.

• Homonymous hemianopia with macula sparing
• Cortical blindness
• Visual agnosia

• Wernicke's aphasia: Speech remains fluent but word substitutions + neologisms.
• Superior homonymous quadrantanopia
• Auditory Agnosia
• Prosopagnosia

• Broca's Aphasia: Speech not fluent, laboured, halting.
• Disinhibition
• Perserveration - repetitive thinking + behaviour
• Anosmia
• Inability to generate a list

Thalmus + mammilary bodies of hypothalamus

Caudate Nucleus of the basal ganglia.

Substantia nigra pars compacta.

Hypersexuality, Hyperorality, Hyperphagia, Visual agnosia. Lesion of the amygdala.

Presents with Nehrotic syndrome or proteinuria.

• Thickening of basement membrane and deposition electron dense material causing a 'spike and dome' pattern.
• Causes = Infective (malaria + hepB)
• Malignant (lymphoma, lung ca, leukaemia)
• Drugs (gold, penicillamine, NSAIDS)
• Idiopathic
• SLE

Third commonest cause of ESRF

Rule of thirds 13 recover, 13 remain proteinuric, 13 progress to ESRF.

Immunosupression + ACEI for management

• Co-trimoxazole (also useful for prophylaxis)
• Pneumothorax, Hepatosplenomegaly, lymphadenopathy, choroid lesions.
• IV pentamidine.

• Squamous: Clubbing, HPOA, PTHrp
• Small cell: ADH, ACTH, LEMS

C-peptide will tell you wether the insulin is exogenous or endogenous.

• Learning difficulties cuggest homocystinuria.
• AR disease resulting in deficiency of cystathione beta synthase. Diagnosed with syanide-nitroprusside test and treated with VitB6 (pyridoxine.

• Student's T-test - Paired or unpaired data.
• Pearson product moment co-efficient - Correlation.

• MM = IgG or IgA
• Waldenstroms = IgM

Same as zero order. E.g. phenytoin and alcohol.

• Ash-leaf spots - depigmented spots that fluoresce under UV.
• Shagreen patches - rough skin over lumbar spine.
• Subungual Fibromata
• Cafe-au-lait spots
• Adenoma Sebaceum - butterfly distribution around nose.

• Bilateral sensorineural deafness, progressive renal impairment and X-linked dominant in most cases (more severe in males).
• Can also present with Lenticonus (lens protruding into the ant.chamber) and retinitis pigmentosa.
• Classic exam question involves a pt with Alport's who has a renal transplant which is failing because they develop Goodpastures.

• Full dose PPI + clarithromycin +
• EITHER amox or metronidazole.

• Berger's disease Mesangioproliferative glomerulonephritis.
• Histopathology will show Mesangial hypercellularity because IgA is all over it and +ve immunofluorescence for IgA and C3.

• Usually a lag between sore throat and onset of renal probs in Post-strep (hence the POST bit)
• Post-strep usually has proteinuria rather than haematuria
• Post-strep assoc with low complement levels.

• Young male with recurrent episodes of macroscopic haematuria assoc with mucosal infections (eg URTI).
• Nephrotic range proteinuria is rare
• Can progress to renal failure.

• 25% develop ESRF
• Frank haematuria = GOOD prognosis
• males, proteinuria >2gday, hypertension, smoking, hyperlipidaemia, ACE genotype DD.

• >40yrs old
• Nulliparity
• Multips
• High BMI
• Diabetes
• +ve FHx, PMHx
• Pre-existing HTN or Renal disease.

• Labetalol, Nifedipine and Hydralazine IN THAT ORDER.
• 160110 would be a good starting point but if they are symptomatic or showing signs of increasing severity in any way, start earlier.

• Renal involvment
• Nervous system involvment

• Most common - Procainamide, Hydralazine
• Less common - isoniazid, minocycline, phenytoin.

Radioiodine treatment

Smoking.

• Paracetamol
• valproate, phenytoin
• Anti-tb drugs - isoniazid, rifampicin, pyrazinamide
• Statins
• amiodarone
• methyldopa

• OCP
• Antibiotics
• Phenothiazines - chlorpromazine, prochlorperazine
• Sulfonylureas
• Fibrates

• Progressive marrow failure
• Massive lymphadenopathy
• Massive splenomegaly
• Systemic symptoms
• Lymphocytosis of >50%in 2months or doubling time <6months
• Autoimmune cytopenias (eg ITP)
• Treatment is FCR (Fludarabine, cyclophos and rituximab)

• Huntingtons, Ataxic telangectasia, Wilsons
• SLE
• Carbon monoxide poisoning
• Rheumatic fever: Sydenhams chorea
• Drugs: OCP, Ldopa, antipsychotics
• Neuroacanthocytosis
• Polycythemia Ruba Vera
• Cerebrovasc disease

• The M rule:
• IgM
• Mitochondrial antibodies
• Middle aged females

• UC
• 80%of pts with PSC have UC.

ERCP - shows views of the liver with a 'beaded' appearence of the lobules

ANCA- may be positive

Liverbiopsy - my show onion skin appearence.

• GFR-ACD
• Glomerulosa - Aldosterone
• Fasiculata - Cortisol
• Reticularis - DHEA and the androgens

• First line = Clomiphene
• Second line = Metformin

Can be used in conjunction.

• Actinomyces
• Bacillus anthracis
• Clostridium
• Diptheria: coryne bacterium diptheriae
• Listeria monocytogenes

• Proliferation of abnormal megakaryocytes in bone marrow which give out lots of platelet derived growth factor. This stimulates fibroblasts in the marrow that the cause fibrosis.
• Because of a lack of haematopoesis from marrow, spleen + liver take over (hence massive splenomegaly).

• Always in old people
• Fatigue (most common)
• Massive splenomegaly
• Hypermetabolic symptoms (night sweats + wt loss)

• Bloods = Anaemia, High WBCs and platelets early in disease. High urate + LDH (high cell turnover).
• Blood Film = Tear-drop poikilocytes.
• Bone marrow biopsy = unobtainable'dry tap' therefore requires trephine.

• PCOS
• Cushings
• obesity
• Androgen therapytumor
• drugs eg phenytoin

• Minoxidil, ciclosporin, diazoxide
• Porphyria cutanea tarda
• Anorexia Nervosa
• Congenital causes

• Bosentan = endothelin receptor antagonist
• Used for primary pulmonary hypertension

• Adult T cell lymphoma.
• HTLV-1 = human t-cell lymphotropic virus

• EBV = burkitt's, nasopharyngeal carcinoma
• HIV = high grade B-cell lymphoma
• H.pylori = Gastric Lymphoma (MALToma)
• Malaria = Burkitt's lymphoma.

• Parapneumonic: Low pH or Turbid
• TB: Low glucose, blood staining.
• RA: Low glucose
• Pancreatitits: Raised amylase
• Oesophageal perforation: Raised amylase
• Mesothelioma: Blood staining
• PE: Blood staining

• Remember CAGE
• Creatinine
• Age
• Gender
• Ethnicity

• Heart Failure (reduces all cause mortality in latter stages)
• Conn's (as an aldosterone agonist)
• PCOS (as an anti androgen)
• Nephrotic syndrome.

SE=Hyperkalemia + Gynaecomastia

• Necrolytic Migratory erythema - Glucagonoma
• Acquired icthyosis - Lymphoma
• Acquired hypertrichosis lanuginosa - GI and lung
• Dermatomyositis - Ovarian and lung
• Erythroderma - Lymphoma
• Erythema gyratum repens - Lung
• Migratory thrombophlebitis - Pancreatic
• Pyoderma gangrenosum - Myeloproliferative
• Sweet's - Myelodysplasia
• Tylosis - Oesophageal

• Infection : Streptococcal + TB
• Systemic disease: IBD, Sarcoid, Behcet's
• Drugs: COCP, penicillins, sulphonamides
• Malignancylymphoma
• Pregnancy.

• Lower seizure threshold
• Tendon damagerupture

50% dead at 50!!!

• Secundum
• 70% of ASD. ECG=RBBB+RAD. Fixed splitting of S2 (ejec systolic). Can cause paradoxical embolism.
• Primum
• Present earlier than secundum. ECG = RBB + LAD, prolonged PR. Assoc with abnormal AV valves.

• Quiet heart sounds
• Small volume complexes in lateral leads.
• Assoc with Kartageners

Third nerve palsy

Horners.

Monoclonal antibody against CD20 on Bcells. Therefore destroys Bcells and is useful in autoimmune disorders, leukemias, lymphomas and transplant rejection.

Anti-EGFR antibody. For metastic CRC and head and neck cancers.

• Cryptosporidium (most common) (Acid-fast)
• CMV
• Mycobacterium avium
• Giardia

H.Pylori eradication. Effective in 80% of low-grade cases.

NIV...7.25-7.35

Invasiv vent...<7.25

Strokes and VTE.

• Hydrocort
• Eumovate
• Betnovate
• Dermovate

• Carotid dissection
• Carotid aneurysm
• Cavernous sinus thrombosis
• Cluster headache

• Post-ganglionic= no anhydrosis
• Pre-Ganglionic = anhydrosis of the face only
• Central lesions = Anhydrosis of face arm and trunk

• Pancoasts Tumor
• Trauma
• Thyroidectomy
• +Cervical rib

These are pre-ganglionic lesions as they cause anhydrosis

• Stroke
• Multiple sclerosis
• Syringomyelia
• Tumor
• Encephalitis

• NF1 has 17 characters ergo chromo 17
• NF2 = ALL THE 2's. chromo 22

• Decreased IgM
• Recurrent chest infections
• Thrombocytopaenia
• Eczema

Myeloproliferative disorder, increase red cell count, can be assoc with increased WCC and platelets too. Underlying aetiology = JAK2 mutation allowing the tyrosine kinase to be hypersensitive to EPO. Epo levels are usually decreased. Symptoms = pruritis especially when limb put in warm water. Erythromelalgia = pain + discolouration of a limb. Gouty arthritis and increased risk of thrombotic events inc budd-chiari.

• Diagnose with genetics for JAK2 mutation.
• Red cell mass + haematocrit secondline.

Treat with phlebotomy, low dose aspirin, hydroxyureacarbamide to decrease RBC prolif.

Haemaglobin which has been oxidised from Fe2+ to Fe3+.

NADH methaemaglobin reductase reduces Fe3+ to Fe2+. This needs to be done cuz Fe3+ doesnt bind oxygen and therefore moves the dissociation curve to the left.

A deficiency in the enzyme causes methaemaglobinaemia. Precipitating factors are Sulphonamides, dapson, nitrates, primaquinen and aniline dyes.

Treat with ascorbic acid.

• 1. t(15;17) PML-Rar-alpha
• 2. Presents in younger people with PC being DIC
• 3. good prognossis

• Androgen insensitivity syndrome
• Becker muscular dystrophy
• Colour blindness
• Duchenne muscular dystrophy
• Fabry's disease
• G6PD deficiency
• Haemophilia A,B
• Hunter's disease
• Lesch-Nyhan syndrome
• Nephrogenic diabetes insipidus
• Ocular albinism
• Retinitis pigmentosa
• Wiskott-Aldrich syndrome

Heart failuremyocarditis

Chagas usually presents with a chagoma at site of infection + periorbital cellulitis.

Iv pentamidine

• Left sternal heave
• Constant machinery murmur
• Collapsing pulse
• Wide pulse pressure.

Majority close with indomethacin.

• Increasing age.
• Afro-Caribbeans.

• Hyposplenism
• Liverdisease
• Fe deficiency anaemia
• Sickle cellthallasemia

Hyposplenism

• G6PD deficiency
• Alpha-thallasemia

• Intravasc haemolysis
• Mechanical heartvalve
• DIC

• Lead poisoning
• thalaasemia.

• Spherocytosis
• Autoimmune haemolytic anaemia.

They all cause Hyperchloraemic acidosis. Therefore causing a metabolic acidosis with a normal anion gap.

Both cause HYPOkalemia.

And obviously both cause Hyperchloraemic acidosis and can be idiopathic.

Small bowel aspiration and culture.

Other tests are hydrogen breath test, 14C-xylose breath test and 14C-glycocholate breath test.

• LTOT
• Stop smoking
• Lung volume reduction surgery.

Rapidly progressive

Focal segmental

Diffuse Proliferative.

Membranous Glomerulonephritis

MembranoproliferativeMesangiocapillary

Leukaemoid reaction = Presence of immature cells in blood stream as they are being 'pushed out'produced too quickly due to acute stressor (e.g, haemmorhage, sepsis, haemolysis, metastic spread to marrow) 

• -high leucocyte alkaline phosphatase score
• -toxic granulation (Dohle bodies) in the white cells
• -'left shift' of neutrophils i.e. three or less segments of the nucleus

• Chronic myeloid leukaemia
• low leucocyte alkaline phosphatase score

• Gets worse with neuroleptics (possibly irreversible)
• progressive cognitive impairment
• parkinsonism
• visual hallucinations (other features such as delusions and non-visual hallucinations may also be seen)

hydrocort x 4 = Pred

Pred x 7 = Dexamethasone.

• Thiazides
• Steroids
• Tacrolimus + Ciclosporin
• Atypical antipsychotics
• Beta blockers
• Nicotinic acid
• Interferon-alpha

• Cryptogenic
• Connective tissue disorders (except AnkSpond)
• Drug induced (meth, bleo, amiodarone)
• Asbestosis

Mnemonic = SCAR

• S=Systemic sclerosis
• C=Crypto + connective tissue disord
• A=Asbestosis
• R=radiation

• B=Berylliosos
• R=Radiation
• E= EAE
• A= Ankspond
• S=Silicosis + sarcoidosis
• T=TB
• + Coal workers and Histiocytosis

• SNOW = South, north, west
• DROP= DNA, RNA, Protein

Pharma= Antispasmodics, Laxatives or Loperamide dependent on predominance, Low dose TCAs.

Psych= CBT or hypnotherapy.

• N=NF1
• A=APC
• R=Retinoblastoma
• P=p53

NARp implying loss of function results in tumor. Both alleles must be mutated.

Norad+dopa reuptake inhibitor + Nicotinic antagonist.

Partial agnoist of nicotinic receptor.

Motivational and psychological therapies.

Can use NRT if above fail.

DO NOT USE brupropion or varenicline.

Bicuspid aortic valve

Ureterosigmoidostomy

Renal tub acidosis

Addisons

• Fistula
• Acetazolamide
• Diarrhoea

quinolone or trimethoprim

Broad-spec cephalosporin or quinolone.

Heart failure, hypotension, bradycardia.

• Flushing
• Headaches
• Ankle swelling (justlike pioglitazone)

• Inability to secrete h+ in distal tubule
• Causes hypokalemia
• Can cause nephrocalcinosis and renal stones
• Causes = idiopathic, RA, SLE, Sjogrens.

• Decreased HCO3- resorption in proximal tubule
• Causes hypokalemia
• Complications include osteomalacia
• Causes=idiopathic, fanconi syndrome, wilson's, cystinosis

• Causes HYPERkalemia
• Causes=hyperaldosteronism, diabetes.

The D rule for Dystrophica Myotonica (DM1)...

• Distal weakness initially
• Autosomal Dominant
• Diabetes
• Dysarthria

Bilateral ptosis + loss of red reflex due to cataracts.

Antibodies against the Gp2b3a or 1b-5-9 complex. Its an immune mediated reduction in platelet count.

• Acute
• More common in kids
• Equal sex incidence
• May follow infection or vaccination
• Self limiting over 2 weeks

• Chronic
• More common in youngmiddle aged
• Relapsing remitting

• Evans syndrome
• ITP in assoc with autoimmune haemolytic anaemia.

• Topical metro
• Oral tetra
• Daily high factor suncream
• Camouflage creams
• Laser therapy for the telangectasia.

Trinucleotide repeat on chr 9 FRATAXIN gene.

• Neuro features:
• Absent lower limb reflexes
• Cerebellar ataxia
• Spinocerebellar tract degen
• Optic atrophy

• Other features:
• HOCM
• Diabetes Mellitus
• High arched palate

• Rule of 10cents.
• 10% bilateral, 10%malignant, 10%extra-adrenal(organ of Zuckerkandl at bifurcation of aorta)

Treat with PHenoxybenzamine before b-blockers

Assoc with MEN2, neurofibromatosis and VHL

Amitriptyline or pregabalin

• 6-12 hrs =symptoms
• 36hrs = seizures
• 72hrs = Delerium Tremens

• GLP1 mimetic
• subcut inject 60 mins before morn+eve meal
• good for the situation in which you want to start some one on high dose insulin and they are fatty fatty fat fat
• Continue if they show a good response in first 6 months hba1c drops by 1% and wt loss of >3%

• Nausea and vom
• inceeased risk of severe pancreatitis and renal failure.

GOOD THING!! erythema nodosum confers a good prognosis.

Insisious onset, black people, stage 3 radiographic change and splenomegaly are all bad things.

• Sudden haemorrhage or infarct of pituitary gland.
• Clinically very much like an SAH=headache,nec stiffnes,vomitting
• Classic visual defect
• Extraocular cranial nerve nuropathies
• Features of pit.insufficiency e.g. Hyperkalemic Hypotension due to decreased ACTH secretion leading to aldosterone deficit

• Brady
• First degree HB
• Long qt
• J waves after the QRS

Optic Tract

• CHF
• Hypertension
• Age >75 (2)
• Diabetes
• Previous strokeTIA (2)

• Vascular symptoms
• Age 65-74 (1)
• Sex female = 2

90-95%

Pleas Find My Anaplastic Lymphoma

• Papillary = Most common great prognosis
• Follicular = 2nd commonest.
• Medullary = Assoc Men-2, cancer of the parafollicular calcitonin secreting cells.
• Anaplastic = Worst one
• Lymphoma = Assoc hashimoto's.

• Toxocara species
• Ascaris
• Baylisascaris

• CT disorders
• Cervical rib
• Leukemia
• Type 1 cryoglobulinaemia
• Drugs: OCP, Ergot
• Use of vibrating tools.

Non-contrast CT.

• Anaemia
• INR >1.4
• Platelet <60
• Hadatid cyst
• Extrahepatic biliary obx
• Haemangioma
• Ascites
• Un-co-op pt.

• Venousarterial thrombosis
• Livedo reticularis
• Recurrent fetal loss
• Prolonged APTT
• Thrombocytopenia
• Other: pre-eclampsia, pulmonary hypertension.

Remnant hyperlipidaemia

Caused by triglycerides:

• Hypertriglyceridaemia
• lipoprotien lipase deficit

• Familial hypercholesterolaemia
• Remnant hyperlipidaemia

Surgery, lasers, electrodessication

or topical tricolor acetic acid.

• Alpha = partial hemolysis
• Contains strep pneumo and viridans

• Beta = complete hemolysis 
• betas are divided into groups A-H
• A, B, D only ones important in humans.
• a = strep pyogenes, erisypelas, OM, cellulitis impetigo
• b = strep agalactiae neonatal infection
• d = enterococcus far alias and faecium

• Kidneys have become rubbish And cause
• Type 2 RtA
• glycouria
• aminoaciduria
• phosphaturia
• Osteomalacia

caused by Wilson's, cystinosis,

In hypopituitaryism - give insulin and measure GH and cortisol. If pituitary normal both should rise.

in cushings to differentiate between cushions and pseudocushings.

• Hyperparathyroid
• hypothyroid
• haemochromotosis
• low phosphate or magnesium
• wilsons

• Mitochondrial disorder so classic red ragged fibres on muscle biopsy
• Onset <20 years 
• external opthalmoplegia
• retinitis pigmentosa
• Bilateral ptosis

• Leber's optic atrophy
• MELAS - mitochondrial encephalopathy lactic acidosis stroke like episodes
• MERRF - myoclonus epilepsy with red ragged fibres
• Kearns-Sayre
• sonsorineural hearing loss

• I-single Ln
• II- 2 or more LNs on same side of diaphragm 
• III- LNs on both sides of diaphragm
• III- gone beyond LNs

• A= no systemic symptoms except pruritis
• B= weight loss, fevers, night sweats,

• Bioprosthetic = aspirin
• mechanical = warfarin + aspirin
• aortic INR = 2-3
• mitral = 2.5-3.5

7.5mg of pred for 3 months or more

• Prolactinoma
• Pregnancy
• PCOS
• Oestrogens
• Hypothyroidism (TRH stims lactotrophs)
• Acromegly (1\3d)
• Stress, exercise, sleep.

Taking enzyme inducers.

Malnutrition (Anorexia+bulimia, alcohol, CF, pancreatic insuff, hep c, HIV)

Not having eaten for a few days