Lists for Medical Students

8/12/2019 Lists for Medical Students

1/31

ESSENTIAL LISTS FOR MEDICAL STUDENTS

Many medical students find lists an essential tool for revision. The lists displayed here can

be used as a reference guide or as essential revision facts in themselves.

For more lists, see PasTests title Learning by Lists.

CONTENTS

1. CARDIOLOGY1.1 Essential features of atrial fibrillation

1. !linical features of heart failure1." !linical features of mitral #tenosis

2. CLINICAL PHARMACOLOGY.1 $mportant liver en%yme inducers of cytochrome P&'(. E)amples of clinically important drug reactions

." *rug +metabolism in elderly people

3. DERMATOLOGY".1 !auses of +s-in hyperpigmentation

". ail changes in health and disease

4. ENDOCRINOLOGY&.1 !linical features of thyroid disease

&. +!linical features of /cromegaly&." +Essential features of 0ypoadrenalism

5. GASTROENTEROLOGY'.1 Essential features of coeliac disease'. Features of ulcerative colitis and !rohns disease'." Essential features of viral hepatitis

6. GENETICS.1 +!linical features of Marfan syndrome. !onditions inherited in an /utosomal dominant manner

7. GENERAL SURGERY2.1 +!linical features of 3reast cancer

2. !auses of testicular lumps

2." +!linical features of groin hernias

8. HAEMATOLOGY

4.1 +Essential features of $ron deficiency anaemia4. 5aboratory findings in coagulation disorders4." !linical features of #ic-le cell disease

9. HIV


2/31

6.1 7espiratory complications of 0$8

10. IMMUNOLOGY

1(.1 /utoantibodies and disease1(. +Essential features of !7P

11. INFECTIOUS DISEASE11.1 +!linical features of malaria11. +Essential features of 5yme disease

12. METAOLIC1.1 +Essential features of 0ypocalcaemia1. $nterpretation of results in patients 9ith bone disease1." +Essential features of 0yper-alaemia

13. RENAL1".1 $nvestigation of acute renal failure

1". +!linical features of osteodystrophy1"." Management of chronic renal failure

14. NEUROLOGY

1&.1 !lincal features of "rdnerve palsy1&. !linical features of subarachnoid haemorrhage1&." !linical features of !arpal tunnel syndrome

15. OPHTHALMOLOGY1'.1 Eye signs in medical disorders table &1'. *iabetic eye disease

16. RESPIRATORY1.1 +!linical features of !:P*1. +!linical features of T3

1." +!linical features of cystic fibrosis

17. RHEUMATOLOGY12.1 +!linical features of 7heumatoid arthririts

12. /nti;rheumatoid drugs12." +!linical features of 7aynauds phenomenon


3/31

1. CARDIOLOGY

1.1 E!!"#$%&' ("&$)*"! +( &$*%&' (%,*%''&$%+#1. !auses

a. !ardiac

i. M$ and $0*ii. 8alvular heart disease +especially M#iii. !ongenital heart disease

iv. !ardiomyopathy +especially dilatedb. 7espiratory causes

i. PEii. Pneumonia

c. :thersi. 0ypertensionii. 0yperthyroidism

iii. /lcohol +and other drugsiv. $diopathic +&4 hrs after onset or after 9ee-s anticoagulation

ii. *! cardioversioniii. Flecainideiv. #otalol

v. /miodarone

d. 7ate !ontroli. *igo)in ;doesnt control rate effectively alone in active patientsii. 8erapamil

iii. 3eta bloc-erse. Prophyla)is for paro)ysmal /F

i. #otalolii. Flecainide

iii. /miodarone

f. /nticoagulation +ris- of stro-e ";fold

1.2 C'%#%-&' ("&$)*"! +( "&*$ (&%')*"

1. #ymptomsa. 58F

i. #:3

ii. !ough +dry or pin- frothy sputumiii. :rthopnoea and P*iv. !ardiac 9hee%e

b. 78F

i. Peripheral oedema


4/31

ii. /scites. #igns

a. 3iventricular failure

i. 0ypotensionii. Tachycardiaiii. ?allop rhythmiv. *isplaced ape) +dilated heart

b. 58Fi. 3ilateral crepitationsii. Pleural effusions

c. 78Fi. Peripheral oedemaii. 7aised @8P +may have giant 8 9aves if T7iii. 0epatomegaly

iv. /scitesd. !A7 changes in 58F

i. Bpper lobe diversion

ii. !ardiomegalyiii. /lveolar oedemaiv. Cerley 3 linesv. Pleural effusions

1.3 C'%#%-&' ("&$)*"! +( /%$*&' S$"#+!%!1. !auses

a. 7heumatic fever

b. !ongenitalc. !arcinoid syndromed. #5E

. #ymptoms

a. 3reathlessnessb. 0aemoptysisc. Palpitations

d. 7ecurrent chest infectionse. /cute pulmonary oedema

". !linical signsa. Malar flush

b. /Fc. Tapping undisplaced ape)d. :pening snap +mobile valve

e. Mid diastolic murmur

f. Evidence of pulmonary hypertension +T7, 78 heave, 78F&. Treatmentsa. Treat /F +rate control and anticoagulation

b. Endocarditis prophyla)isc. Treat heart failured. 8alvuloplastye. :penDclosed valvulotomy

f. M87


5/31

2. CLINICAL PHARMACOLOGY

2.1 I/+*$$ '%"* "#/" %#)-"*! +( -$+-*+/" P450P! 37/##

1. Phenytoin

2. Carbama%epine

3. arbiturates

4. Rifampicin

5. Alcohol +chronic

6. Sulphonylureas

7. Smo-ing

2.2 E&/'"! +( -'%#%-&'' %/+*$$ *) *"&-$%+#!

D*) D*) E(("-$

/%athioprine /llopurinol Aanthine o)idase inhibition leads to a%athioprineto)icity

/lcohol Metronida%ole!hlorpropamide

Flushing, hypotension

M/:$s Tyramine/lpha;agonists

/mphetamines

/cute hypertensive crisis


6/31

4. Polypharmacy leads to more interactions

3. DERMATOLOGY

3.1 C&)!"! +( "*%/"#$&$%+#1. Metabolic

a. 7enal failureb. !irrhosisc. 0aemochromatosis

. *rugs eg /miodarone". Endocrine

a. /ddisons diseaseb. !ushings syndrome

c. elsons syndrome +hyperpigmentation post;bilateral adrenalectomyd. Pregnancy

&. utritional +Pellegra

'. 5ymphoma

3.2 N&%' -"! %# "&'$ %!"&!"

N&%' -" C&)!"!

Pitting and ridges Psoriasis

:nycholysis Psoriasis:nychomycosis +fungal nail infectionThyroid disease

Trauma

?rooves /cute illness +3eaus linesPsoriasis

5euconychia and hite bands 0ypoalbuminaemia!irrhosis

Gello9 nails Gello9 nail syndrome

Coilonychia $ron deficiency anaemia

#plinter haemorrhages Trauma +commonest cause3acterial endocarditis

!onnective tissue disorders

ailfold telangiectasia !onnective tissue disorders

4. ENDOCRINOLOGY

4.1 C'%#%-&' ("&$)*"! +( $*+% %!"&!"H"*$*+%%!/ H+$*+%%!/

C+#!$%$)$%+#&'

("&$)*"!

eight loss

0eat intolerance/n)iety!lubbing

eight gain

!old intolerance5ethargy0oarse voice

CVS Tachycardia/F

3radycardiaPericardial effusion


7/31

!ardiac failure !ardiac failure

S%# 0air loss

#9eatingPretibial my)oedema +?raves

0air loss

*ry s-inPuffy face

M"#!$*)&' /menorrhoea Menorrhagia

GI *iarrhoea !onstipation

CNS TremorPro)imal myopathyPsychosis

#lo9 rela)ing refle)es*epressionPoor memory

!arpal tunnel syndrome

Bloods T" T&

T#0Microcytic anaemia

T" T&

T#0Macrocytic anaemia

T*"&$/"#$ 3eta 3loc-ers!arbima%ole

7adioactive $odine#urgery

Thyro)ine

4.2 C'%#%-&' ("&$)*"! +( A-*+/"&' H"*!"-*"$%+# +( GH:1. 6'H due to pituitary tumour

. *iagnosisa. Failure of ?0 to suppress to oral glucose load may get parado)ical rise.b. 7aised serum $?F;1 levelsc. 8isual fields

d. M7$ pituitary". Features

a. E)amination

i. !oarse facial appearance

ii. 5arge hands D feet D hat si%eiii. Enlarged lo9er a9iv. !arpal tunnel syndrome

v. 0yperhydrosisvi. /rthropathy

b. Metabolici. 0ypertension

ii. *iabetes mellitusc. !ardiorespiratory

i. $ncreased cardiovascular mortality

ii. :bstructive sleep apnoeaiii. 580 and cardiomyopathy

d. :thersi. 7enal stones

ii. $ncreased ris- of colon cancer&. Treatment

a. Pituitary surgery

b. :ctreotide +somatostatin analoguec. Pituitary irradiationd. 3romocriptine.


8/31


9/31

i. *ermatitis herpetiformis. 0yposplenism

k. !aD:steomalaciaDosteoporosisl. $g/ deficiency +'H

. *iagnosis

a. *uodenalDeunal biopsy; intraepithelial lymphocytes, villous atrophyb. Tissue transgluaminase +tT? /bs most accuratec. Endomysial /b

2. Treatmenta. ?luten free diet ; " month recovery of villous atrophy

b. Treat deficienciesc. #creen for and treat osteoporosis

5.2 F"&$)*"! +( C*+#;! %!"&!" )'-"*&$%" -+'%$%!

C*+#;! %!"&!" U'-"*&$%" -+'%$%!

1. /ffects any part of the ?$ tract frommouth to anus.

. !ommonly terminal ileum, colon,anorectum.

".


10/31

1. !olonoscopy and biopsy. 3arium studiesL

a. !obblestoning of mucosab. 7ose thorn ulcers

c. #-ip lesions". $sotope leucocyte scans useful to

diagnose active small bo9el disease

1. !olonoscopy and biopsy. 3arium studiesL

a. Pseudopolypsb. 5oss of haustral pattern

c. Featureless shortened colon

C+/'%-&$%+#!

1. FistulaeLa. entero;enteral

b. entero;vesicalc. entero;vaginald. perianal

. !arcinoma ; slightly increased

incidence of colonic malignancy". /bscess formation

1. Fistula do not develop. To)ic megacolon +urgent indication for

colectomy

3. $ncreased incidence of carcinoma;(after (years of disease

&. Preventative colectomy of value'. $ron deficiency anaemia

T*"&$/"#$

5ASA -+/+)#!< +eg mesala%ine :ral and topical treatment for flares of diseaseand prevention of relapses

S$"*+%!< Topical, oral or parenteral for treatment of flare up +not maintenance

A&$%+*%#"


11/31

Fulminant hepatitisrare.!hronic 0!8 cansuccessfully be

treated 9ithinterferon andribavirin +'(Hresponse

+chronic 0!8+"(H ris- ofcirrhosis after "(years of infection.

0igh ris- of 0!!.

* 3lood.

*ependantonconcurrent038

infectionforreplication

$ncom

plete

E)acerbates

038 infectionand increasesris- of hepaticfailure and

cirrhosis

$nterferon of limited

benefit

$ncreases incidence

of cirrhosis inchronic 038

E Faecal;oral 7/ /symptomatic@aundiceMalaiseausea

#upportive/cute self limitingillness$n pregnancy

mortality +fetal andmaternal of ' H

o

6. GENETICS

6.1 C'%#%-&' ("&$)*"! +( M&*(! !#*+/"

1. Mutation of fibrillin +constituent of connective tissue !hromosome 1'. Features

a. Tall stature +armspan heightb. /rachnodactyly +long fingers

c. 0igh arched palated. #coliosise. 0ypere)tensile oints

f. Bp9ard lens dislocationg. /ortic root dilatation +/7, aortic dissectionh. Mitral valve prolapse and M7

6.2 C+#%$%+#! %#"*%$" %# A)$+!+/&' +/%#$ /#"*

1. /dult polycystic -idney disease. ?ilberts syndrome

". 0untingtons chorea&. 0ereditary spherocytosis'. Marfans syndrome. Myotonic dystrophy

2. eurofibromatosis4. oonans syndrome


12/31

6. :steogenesis imperfecta1(. Familial Polyposis coli11. Tuberous sclerosis

1. 8on illebrands disease.

7. GENERAL SURGERY

2.1 !linical features of breast cancer1. /denocarcinoma

a. *uctal carcinoma 6(Hb. 5obular carcinoma 1(H

. Most common cancer in 9omen". 1H of breast cancer occurs in males

&. 7is- factorsa. /dvanced ageb. Family history +particularly mother and sister

c. orth /merica or northern European descentd. 0igh postmenopausal blood oestrogen levele. 0igh socioeconomic statusf. /ge at first full;term pregnancy older than "( years

g. 0istory of cancer in the other breasth. /ny first;degree relative 9ith a history of breast canceri. ulliparity

. 0istory of endometrial or ovarian cancer

'. ?eneticsa. 37!/1 and mutations confer increased ris- of breast cancerb. "H of the breast cancer population have 37!/ 1 +2(H of 9omen 9ith early;onset

breast cancer

c. 2( H of subects 9ith 37!/1 develop breast cancer in their life timed. 37!/ lifetime ris- is ';"(H

6. Presentationa. May be asymptomatic and diagnosed by screening mammographyb. Painless palpable breast lump

i. !linical characteristics of malignant breast lumps1. $rregular hard lump

. Bsually painless". :ften fi)ed to the s-in or chest 9all&. #-in dimpling

'. ipple retraction

. 3loody dischargeii. !haracteristics of 3enign lumps +4(H of breast lumps

1. Firm regular rubbery mass

. :ften painfulc. ipple discharged. Pagets disease of the nipple

e. Peau dorange2. *iagnosis


13/31

a. Mammographyb. Bltrasoundc. Fine needle aspiration

d. !ore biopsye. :pen biopsyf. !T and bone scan to loo- for metastases

4. Treatment +dependant on stage, comple) and constantly being optimised

a. 5umpectomyb. Mastectomyc. Mastectomy and a)illary clearance

d. 7adiotherapye. /duvent chemotherapy +constantly evolvingf. 0ormonal therapy +for oestrogen receptor positive disease

i. Tamo)ifen

ii. /nasta%ole

7.2 C&)!"! +( $"!$%-)'&* ')/!

1. Painlessa. 0ydrocoeleb. 8aricocoelec. #permatocoele

d. Epididymal cyste. Testicular cancer +sometimes

i. #eminomasii. Teratoma

iii. Mi)ed seminoma;teratomaiv. 5ymphomav. Gol- sac tumours

. Painful

a. Epididymo;orchitisb. Torsionc. #ome testicular cancers

d. 0ernias

7.3 C'%#%-&' ("&$)*"! +( *+%# "*#%&!1. $ndirect inguinal +(H

a. 0erniation that e)tends do9n the inguinal canal and may enter the scrotumb. Failure of the obliteration of the processus vaginalisc. Medial and above the pubic tubercle

d. Bsually has a cough impulse

. *irect inguinal +'Ha. ea-ness in the abdominal 9all due to increased abdominal pressureb. Protrudes through transversalis fascia in the posterior 9all if the inguinal canal

c. Medial to the inferior epigastric vessels". Femoral +1'H

a. More common in 9omenb. Passes do9n the femoral canal

c. 5ateral to the pubis tubercled. !ommonly becomes incarcerated leading to small bo9el obstruction


14/31


15/31

". 0b# becomes insoluble and leads to cell sic-ling in hypo)ic conditions&. !ommon in blac- /fricans'. 7educed susceptibility to falciparum malaria

. 0etero%ygotes 0b/# N sic-le cell traita. Mild often asymptomatic. May get sic-ling under ano)ic conditions

2. 0omo%ygotes 0b## N #ic-le cell diseasea. !hronic haemolytic anaemia

b. 7ecurrent crises4. #ic-le cell crisis precipitated by

a. 0ypo)ia

b. $nfectionc. *ehydrationd. #ystemic illness

6. Features of crisis

a. Pain due to bone marro9 infarctionb. #ic-le dactylitis infarction of small bones of hands and feetc. #plenic infarction leads to hyposplenism

d. Thrombotic stro-ee. 7etinopathyf. Pulmonary infarction;chest syndromeg. Priaprism painful sustained erection

1(. :ther featuresa. /plastic crisis usually precipitated by parvovirus 316 infectionb. /vascular necrosis of nec- of femurc. 5eg ulcers

d. ?allstones +pigmented due to haemolysis11. *iagnosis

a. 0aemoglobin elecropheresis

b. 3lood film anaemia, sic-le cells, increased reticulocyte count, target cells

c. Positive sic-ling test

9. HIV

9.1 R"!%*&$+* -+/'%-&$%+#! +( HIV1. 8iral infections

a. /denovirusb. $nfluen%ac. !M8

. 3acterial

a. Streptococcus pneumoniaeb. Staphylococus aureusc. Tuberculosis

i. !ommon presentationii. E)tra pulmonary disease commoniii. *oes not tend to have classical !A7iv. Multi;drug resistance is more common

v. /typical mycobacterium infections occur e.g M. avium complexvi. !an occur 9ith any !*& count


16/31

". Pneumocystis carinii pneumoniaa. !ommon presentationb. Bsually occurs 9hen !*& >((

c. /bnormal !A7 in 6(Hd. 0ypo)ice. *ry cough, fever, malaisef. Treatment is 9ith high dose co;trimo)a%ole

&. Fungala. !andidab. Histoplasmosis

c. !ryptococcus

10. IMMUNOLOGY

10.1 A)$+$%,+%"! %!"&!"

D%!"&!" A#$%"#

0ashimotos thyroiditis ThyroglobulinThyroid pero)idase

?raves disease T#0 receptor

Pernicous anaemia $ntrinsic factor Parietal cell

/ddisons disease /drenal corte) cells

$**M !ytoplasm of islet cell

$nsulin?lutamic acid decarbo)ylase +?/*

Myasthenia gravis /cetyl !holine receptor

5ambert Eaton syndrome !a channels on nerve endings

?ullain;3arre syndrome Peripheral nerve myelin components?oodpastures syndrome ?lomerular and lung basement membrane

/$ haemolytic anaemia Erythrocytes

$TP Platelets

P3! Mitochondria

#ome male infertility #permato%oa

10.2 E!!"#$%&' ("&$)*"! +( CRPBseful in monitoring inflammation/cute phase reactant produced mainly in the liver

7ises 9ithin hoursFalls in ;" days

Mar-ed elevation3acterial infection

/bscess!rohns disease!onnective tissue diseases +e)cept #5Eeoplasia

Traumaecrosis


17/31

ormal or slight elevation8iral infection#teroidsDoestrogens

B!#5E

11. INFECTIOUS DISEASE

11.1 C'%#%-&' ("&$)*"! +( /&'&*%&

!aused by the proto%oanplasmodiumsp#pread by bite of female anophelesmosIuito& types

3enign

8iva):valeMalariae

MalignantFalciparum

!linical features

Fever 9ith drenching s9eats7igors0eadacheMyalgia

* and 83enign malaria is not life threatening and is treated 9ith chloroIuine for " days follo9ed by

primaIuine for 9ee-s +eradicate liver cycle

Falciparum malaria

!omplications!erebral malaria +Bp to 1(H mortality0aemolytic anaemia

Metabolic acidosis0ypoglycaemia/cute renal failurePulmonary oedema

0igh parasite count N more severe diseaseTreatment

:ral or $.8. Juinine

/lternatives include Malarone, MefloIuine

*iagnosis#erial thic- and thin films7apid antigen tests

:ther results/naemiaThrombocytopenia0ypoglycaemia

/bnormal coagulation


18/31

Remember always to consider malaria in patient who has travelled to malariaous area evenif they have taken prohpylaxis

11.2 E!!"#$%&' ("&$)*"! +( L/" D%!"&!"

1. Tic-;borne disease ; most common in B#/

2. /etiologic agent is the spirochete orrelia burgdorferi". Transmitted from animals to humans by harbouring infected tic-s&. Typically divided into " clinical phasesL

a. Early local disease

i. Fever, malaiseii. /rthralgia +oint painiii. Myalgia +muscle pain

iv. 0eadachesv. Erythema migrans target lesion sat site of tic- bite

b. Early disseminated diseasei. :ccurs 9ee-s to months after initial infection

ii. eurological disease +especially meningitis and 3ellOs palsyiii. Myocarditisiv. /rthropathy 9ithout oint effusion

c. 5ate disseminated disease +previously called #tage "

i. :ccurs months to years after initial infectionii. Typified by chronic arthritis andDor encephalopathy +sleep disturbances,

fatigue, personality changes.

12. METAOLIC

12.1 E!!"#$%&' ("&$)*"! +( +-&'-&"/%&

1. !ausesa. 0ypoparathyroidismb. !hronic renal failure

c. 5o9 levels of vitamin *"d. 0yperphosphataemiae. 0ypomagnesaemiaf. #epsis

g. 7espiratory al-alosish. !alcium deposition + eg acute pancreatitisi. !arcinoma of prostate

. Features

a. Muscle 9ea-nessb. euromuscular e)citabilityc. !onfusion

d. #ei%urese. Tetanyf. !ataracts

g. *ental hypoplasia". Treatment


19/31

a. #upplementation of calcium, vitamin *"

12.2 I#$"**"$&$%+# +( *"!)'$! %# &$%"#$! =%$ ,+#" %!"&!"

*isease !a P:& /5P PT0

0yperparathyroidism

+primary or or

0ypoparathyroidism

:steoporosis

:steomalacia

Pagets

7enal failure or

12.3 E!!"#$%&' ("&$)*"! +( "*&'&"/%&1. !auses

a. #purious

i. 0aemolysisii. E)cessive inta-e +parenteral, oral

b. *ecreased e)cretioni. /cute oliguric renal failure

ii. !hronic renal failureiii. *rugs

1. #pironolactone

. /miloride". /!E inhibitors&. #/$*#

iv. /ddisonQs disease

v. 0ypoaldosteronismc. 7edistribution

i. /cidosisii. 7habdomyolysis

iii. Tumour lysis syndromeiv. *igo)in poisoning

. E!? changes

a. Tenting of T 9avesb. 7eduction in si%e of P 9avesc. $ncrease in P7 intervald. idening J7# comple)es

e. *isappearance of P 9avesf. #inusoidal 9aveform

". Treatment

a. $8 calcium gluconate +stabilises cardiac membranesb. $8 insulin and de)trosec. !alcium resoniumd. Frusemide

e. #albutamol nebulisersf. *ialysis


20/31

13. NEPHROLOGY

13.1 I#"!$%&$%+# +( A-)$" R"#&' F&%')*"1. Full history and e)amination

a. R #ystemic causeb. *rug history;penicillin or #/$*#

c. Family history. Bltrasound scan

a. 7ule out obstruction

b. Cidney si%e +if small then acute on chronic". Brine

a. Microscopy of urine +pgRb. !ulture and sensitivity

c. Proteind. 0aematuriae. !asts

f. 3ence;@ones protein ; myeloma&. $8B +$ntravenous Brogram or !T to loo- for nephrolithiasis'. $sotope renography

a. #tatic e.g. *M#/

b. *ynamic e.g. M/?", *TP/c. !aptopril renogram to loo- for renovascular disease

. 3lood testsa. #pecific

i. /nti;?3M antibodies ?oodpastureQs diseaseii. /!/ #ystemic vasculitis

iii. /nti;ds*/ S/nti;#m #5E

iv. !" nephritic factor Mesangiocapillary? type

v. /#:T and /nti;*/ase Post streptococcal ?vi. 3lood cultures $nfection, especially endocarditis

b. 5ess #pecific

i. !omplement 0igh in vasculitis5o9 in #5E

ii. $mmunoglobulins Polyclonal increase in #5E and vasculitis.Monoclonal increase in myeloma.7aised $gE in !hurg;#trauss.7aised $g/ in 0enoch;#cholein purpura and

$g/ nephropathy

iii. !ryoglobulins !ryoglobulinaemiaiv. !7P $ncreased in most cases but not usually in #5E

v. Eosinophilia *rug induced interstitial nephritis!hurg;#trauss syndrome

vi. 5ymphopenia #5E

13.2 C'%#%-&' ("&$)*"! +( O!$"+!$*+1. 3one disease that results from the metabolic disturbance in renal failure


21/31

2. Pathophysiologyi. 5o9 plasma ioni%ed calcium

ii. *ue toL1. lac- of 1, ' dihydro)yvitamin *. Malabsorption of calcium". 0yperphosphataemia +failure of e)cretion

b. #timulation of Parathyroid hormone release +#econdary 0yperparathyroidismi. *ue toL

1. 0ypocalcaemia. 0yperphosphataemia

". 5o9 1,' *i; +:0 8it *&. /cidosis

". !linical features

a. :steoporosisb. :steomalaciac. /reas of osteosclerosis +rugger;ersey spine

&. Treatment

a. Phosphate binders +e.g. calcium acetateb. 8itamin * +1;alphacalcidolc. Parathyroidectomy

13.3 M&"/"#$ +( C*+#%- R"#&' F&%')*"

1. 3lood pressure control +aim for >1"(D2'a. /!E inhibitorsb. :ther anti;hypertensives

c. *iuretics. 7eduction in proteinuria

a. /!E inhibitors

3. Treatment of anaemia +maintain 0b1(a. $8 ironb. Erythropoetin

&. *ieta. 5o9 salt inta-eb. 5o9 Potassium inta-ec. 0igh !alorie inta-e

5. Treatment of hyperphosphatemia and hypocalcaemia +renal bone diseasea. Phosphate 3indersb. /lphacalcidol

. ?lucose control in *iabetics

2. !ontol hyperlipidaemia

4. 8olume #tatus monitoring6. /void nephroto)ic *rugs

14. NEUROLOGY

14.1 C'%#%-&' ("&$)*"! +( $%* #"*" &'!

1. "rdnerve supplies all the e)traoccular muscles e)cept superior obliIue and lateral rectus


22/31

. !arries parasympathetic pupiloconstrictor fibres". ucleus in pons&. Features

a. *ilated unreactive pupilb. Ptosisc. $nability to move the eye superiorly, inferiorly, mediallyd. Eye do9n and out at rest

'. !ausesa. 8ascularD*iabetesDdemyelinationDtraumab. Posterior communicating artery aneurysm

c. !avernous sinus thrombosis,d. :rbital tumoure. Thyroid eye diseasef. Trauma

14.2 C'%#%-&' ("&$)*"! +( !),&*&-#+% &"/+**&" SAH:

1. !ausesa. 7upture of aneurysm 4(H anterior circulation +mainly ant. communicating

arteryb. 0ypertension

c. /rterio;venous malformationd. Traumae. !ocaine or amphetamine abuse

. #ymptomsa. 0eadache +sudden onset and severeb. 8omitingc. !oma.

". *iagnosis

a. !T scan +6(H diagnostic yieldb. 5umbar punctureL

i. )anthochromia +& hours post episode, clears after 9ee-s

ii. U blood cell count on microscopy +unreliable as (H taps are traumaticc. !T /ngiographyDM7 angiographyD cerebral angiography to find aneurysms

&. Treatment

a. imodipine reduces vasospasm

b. eurosurgical clipping of aneurysm.c. Endovascular embolisation of aneurysm

'. Prognosis

a. "(H mortality from first episode.

. !onditions associated 9ith #/0a. Polycystic -idney diseaseb. Ehlers*anlos syndrome

c. Marfans syndromed. eurofibromatosis type 1

14.3 C'%#%-&' ("&$)*"! +( -&*&' $)##"' !#*+/"1. Median nerve palsy +nerve compressed at 9rist


23/31

. Featuresa. Pain and parasthesia +9orse at nightb. Parasthesia of lateral "V fingers

c. ea-ness of 5:/F musclesL

i. Lateral lumbricals

ii. Opponeus pollicis

iii. Abductor pollicis

iv. Fle)or pollicis brevis". /ssociations +P0/7:L

a. Pregnancy

b. Hypothyroidism

c. Acromegaly

d. Amyloidosis

e. R/

f. Obesity&. $nvestigation

a. Tinels sign tapping on nerve causes tingling

b. Phalens sign prolonged fle)ion of 9rist leads to tinglingc. erve conduction studies

'. Treatment

a. #plinting of 9ristb. #teroid inection to fle)or retinaculumc. #urgical decompression.

15. OPHTHALMOLOGY

1'.1 Eye signs in medical disorders

S%# D%!+*"*3itot spots 8itamin / deficiency

3lue sclera :steogenesis imperfecta

Pseudo)anthoma elasticumEhlers;*anlos syndromeMarfans syndrome0yperthyroidism

3rushfield spots *o9ns syndrome

!orneal arcus 0ypercholesterolaemia +type a and b

:ld age

!orneal calcification #arcoidosis0yperparathyroidism!hronic renal failure8itamin * abuse

Cayser;Fleischer rings ilsons disease

5isch nodules eurofibromatosis

7oth spots #ubacute bacterial endocarditis

5eu-aemia*iabetes


24/31

15.2 D%&,"$%- E" %!"&!" /+!$ -+//+# -&)!" +( ,'%##"!! %# &$%"#$! &" 3060:1. 3ac-ground retinopathy

a. 8isual acuity unaffected

b. Microaneurysmsc. 0aemorrhagesd. 0ard e)udates

. Pre;proliferative retinopathy

a. !otton 9ool spotsb. *ilatation and beading of retinal veinsc. $ntraretinal microvascular abnormalities

3. Proliferative retinopathy +more common in type 1 diabeticsa. eovascularisationb. Treated cases 9ill have panretinal laser burns

&. /dvanced diabetic eye diseasea. 8itreous haemorrhageb. Tractional retinal detachmentc. 7ubeotic glaucoma

5. Maculopathy +more common in type diabeticsa. :edema and e)udatesb. Macular #tars +multiple e)udatesc. 5oss of central vision +peripheral spared

. Treatmenta. ?ood diabetic controlb. Treat hypertensionc. #top smo-ing

d. Treat hypercholesterolaemiae. 7egular fundal e)aminationf. Focal retinal photocoagulation

g. Panretinal photocoagulation

16. RESPIRATORY

16.1 C'%#%-&' ("&$)*"! +( C*+#%- O,!$*)-$%" P)'/+#&* D%!"&!" COPD:1. !hronic progressive disorder characterised by fi)ed airflo9 obstruction that does not

change mar-edly over several months

. Main aetiological factor is smo-ing". Patients have varying degrees of chronic bronchitis and emphysema&. !hronic bronchitis is a clinical diagnosis of productive cough for " months in

consecutive years

'. Emphysema is an pathological diagnosis 9ith destruction of the acinus +but features canbe seen on !T

. Mar-ed morbidity D mortality

2. !linical featuresLa. cough +usually productiveb. #:3

c. hee%ed. 7ecurrent e)acerbations


25/31

P%# )(("* ')" '+&$"*

0yperventilation 0ypoventilation

!:+type 1 resp failure !:+type resp failure

3reathless but not cyanosed !yanosed but not breathless

!or pulmonale

8. FE81D F8! ratio > 2'HW FE81> 4(H of predicted6. Treatments

1(. /cute as for asthma but o)ygen therapy must be controlled as some patients havetype respiratory failure

11. !hronic

a. #topping smo-ing +:nly measure that 9ill slo9 progressionb. $nfluen%a and pneumococcal vaccine

c. Mild disease +FE81(;4(Hi. #hort acting 3eta agonist or ipratropium as reIuired

d. Moderate +FE81&(;'6Hi. 7egular #hort acting 3eta agonist or ipratropium

ii. !onsider corticosteroid trial, if reversibility +1' H improvement in FE81thengive steroid inhaler

e. #evere + FE81>&(Hi. ebuliser trialii. !onsider long term o)ygen therapy

1. !omplicationsa. 7espiratory failureb. 7ecurrent


26/31

a. idespread haematological spread of bacilli'. #ymptoms

a. ight s9eats

b. eight lossc. !oughd. 0aemoptysise. Pleural effusion

f. Meningitis. *iagnosis

a. !A7 +upper lobe shado9ing, loss of volume, cavitation

b. #putum e)amination for acid;alcohol fast bacilli +//F3sc. Early morning urine for //F3sd. 5ymph node biopsye. 3one marro9 aspirate

f. 3ronchoscopy and lavageg. !ulture ta-es at least 9ee-s

2. Treatment

a. Triple therapy 9ith rifampicin, isonia%id and pyra%inamideb. /dd ethambutol for those 9ith 0$8 or from area associated 9ith resistancec. Triple D Iuadruple therapy for months, rifampicin D isonia%id further & monthsd. !ompliance very important

e. #ide effects commoni. 7ifampicin

1. 0epatitis. ausea

". Pin- D orange urine&. En%yme inducer

ii. $sonia%id

1. 0epatitis

. Peripheral neuropathy +cover 9ith pyrido)ineiii. Pyra%inamide

1. 0epatitis

. 7ash". ?out

iv. Ethambutol1. :ptic neuritis

. 7enal dysfunction

16.3 C'%#%-&' ("&$)*"! +( -!$%- (%,*+!%!

1. /utosomal recessive

. 1 in ' adults carriers". $ncidence 1 in ((( live births&. ?ene on long arm of chromosome 2 codes for cystic fibrosis transmembrane regulator

protein +!FT7

5. "((K mutationsW commonest is deletion of " bases called '(4 +4H of cases. *efect of chloride and 9ater transport across epithelial cell membrane

2. *iagnosis by s9eat testW sodium and chloride concentrations ( mmol D l4. 5ife e)pectancy improving + &(yrs.6. 7espiratory features


27/31

a. :bstruction of small air9ays 9ith thic- mucus due to chloride secretion and sodium resorption leading to bronchiectasis

b. !olonisation 9ith S. aureus! H. "nfluen#ae! Pseudomonas aeruginosa.andurkholderia cepacia

c. Treat 9ith antibiotics, acutely and prophylactically1(. ?astrointestinal features

a. Pancreatic insufficiency in 4(Hb. Meconium ileus in infancy, small bo9el obstruction in adultsc. !hronic liver disease seen due to biliary obstructiond. ?allstones

e. Pancreatitis11. :ther features

a. *iabetes + "(H of patients in late teensb. Pneumothora) +'H

c. $nfertility +almost all mend. :steoporosis

17. RHEUMATOLOGY

17.1 C'%#%-&' ("&$)*"! +( *")/&$+% &*$*%$%!

1. This is an autoimmune chronic inflammatory polyarthropathy. 7evised /merican !ollege of 7heumatology criteria for the classification of rheumatoid

arthritis +1642 +7/ if at least & of the 2 criteriaa. Morning stiffness +1hr for 9-s

b. /rthritis of N" oint areas for 9-sc. /rthritis of the hand oints for 9-sd. #ymmetrical arthritis

e. 7heumatoid nodulesf. #erum rheumatoid factorg. 7adiographic changes

". @oint involvement in 7/

a. #ymmetrical polyarthropathy affectingL

i. M!P 6(Hii. P$P 6(H

iii. MTP 6(H

iv. rists 4(H

v. Cnees 4(H

vi. /n-leDsubtalar 4(Hvii. #houlder (H

viii.0ip '(Hix. Elbo9 '(H

x. !ervical spine &(H&. Features of rheumatoid hands

a. #ymmetrical deforming polyarthropathy affecting M!P, P$P and 9rist oints

b. #pares *$Pc. /ctive oints are hot, s9ollen and tender.d. Blnar deviation at M!P


28/31

e. #ublu)ation at M!P and 9ristf. #9an nec- deformityg. 3utonniere deformity

h. X deformity of thumbsi. asting of dorsal interossei

. /bsence of psoriatic nail changes-. ail fold infarcts or vasculitic lesions

l. Evidence of carpal tunnel syndromem. Palmer erythema

'. E)tra;articular features of 7/

a. on;organ specifici. eight lossii. Fever iii. 5ymphadenopathy

iv. 7heumatoid nodules +patients 9ill be rheumatoid factor Kvev. Feltys syndromevi. /myloidosis

vii. $ncreased susceptibility to infectionsviii.:steoporosis

b. :rgan #pecifici. !ardiac

1. Pericarditis and effusion. 8alvular heart disease

ii. Pulmonary1. Pleurisy

. Pleural effusion". $nterstitial fibrosis&. odular lung disease

'. 3ronchiectasis

. !aplans syndrome +nodules and progressive massive fibrosis in coal9or-ers

iii. eurological

1. !ompressive neuropathies eg carpal tunnel syndrome. Mononeuritis multiple) +vasculitis". !ervical myelopathies

iv. 7enal

1. /myloidosis. *rug induced glomerulonephritis or interstitial nephritis

v. :cular

1. Episcleritis and #cleritis

. #cleromalacia perforans". #ogrens #yndrome. 5aboratory findings in 7/

a. /naemia; normochromic or hypochromic, normocyticb. Thrombocytosisc. 7aised E#7d. 7aised !7P

e. 7aised ferritinf. 5o9 iron concentration


29/31


30/31

iv. *rug induced lupusv. Myasthenia gravisvi. Thrombocytopena

vii. Pancytopenia&. #ulpha%ala%ine

a. #ulphapyridine +active molecule decreases inflammatory reactions and systemicallyinhibits prostaglandin synthesis.

b. #ide effectsi. auseaii. #-in rashes

iii. 0epatitisiv. Pulmonary eosinophiliav. 0aemolytic anaemiavi. Pancytopenia

vii. 7educed sperm +reversible'. Methotre)ate

a. Folic acid antagonist cytoto)ic drug

b. 3inds to dihydrofolate reductase and interferes 9ith */ synthesis and cellreplication

c. #ide effectsi. 0epatic fibrosis

ii. 3lood dyscrasias. !yclophosphamide

a. Po9erful immunosupressant that reduces both antibody mediated and cellmediated response

b. #ide effectsi. 0aemorrhagic cystitisii. Pancytopenia

2. /%athioprine

a. $nhibits nucleic acid synthesis, suppressing cell;mediated hypersensitivity andaltering antibody production.

b. #ide effects

i. 3one marro9 suppressionii. !holestatic hepatitisiii. ausea and vomitingiv. Pancreatitis

17.3 E!!"#$%&' ("&$)*"! +( R&);! "#+/"#+#1. Episodic event characterised by the digits turning 9hite and numb, then cyanosed and

finally red and painful +rebound hyperaemia

. ";1(H of adults affected". 1H of 7aynauds sufferers have a connective tissue disorder&. !auses

a. $diopathicb. !onnective tissue disordersc. !ervical ribd. $ncreased plasma viscosity

e. *rugs; 3eta bloc-ersf. 8ibrating instruments


31/31

'. Treatmentsa. armthb. o smo-ing or 3eta bloc-ers

c. !alcium channel bloc-ersd. ?Te. Prostacyclin infusion

Lists for Medical Students

Documents

Transcript of Lists for Medical Students