Usmle Top 100 Diseases

8/15/2019 Usmle Top 100 Diseases

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Top 100 diagnosis

Hypertension

Hypertension is a common disorder that is defined as sustained elevation of systolic blood pressure (BP) >160 mmHg and/or diastolic BP > 0 mmHg! "hree successive readings are typically re#uired for diagnosis!

$hat to learn

• %is& factors and causes of primary and secondary hypertension

• 'ongterm ris&s of uncontrolled hypertension• rug treatment of hypertension

Ischemic heart disease (IHD)*schemic heart disease is a condition caused by reduction or cessation of the blood supply to the

myocardium! *t gives rise to four main syndromes+ stable angina, unstable angina, myocardial infarction,and sudden cardiac death! "he most important cause of *H is atherosclerosis!

$hat to learn

• Pathophysiology and causes of atherosclerosis

• -ardiac ris& factors

• iagnosis and management of myocardial infarction• *nterventions and drugs in the longterm management of *H

Heart failure

Heart failure can be defined as the inability of the heart to maintain sufficient cardiac output to ade#uately

perfuse the tissues for normal metabolism! *t can be caused by conditions that damage heart muscle(e!g!, *H or cardiomyopathies) or that demand increased .or& of the heart (e!g!, systemic hypertension

or valvular heart disease)!

$hat to learn

• -auses of heart failure

• ymptoms and signs of right and leftsided heart failure• -ompensatory mechanisms in heart failure

• edical management of heart failure

Arrhythmia

ny deviation from the normal sinus rhythm of the heart is &no.n as an arrhythmia! rrhythmias areclassified clinically by site of origin (supraventricular or ventricular) and heart rate (bradycardia or

tachycardia)!

$hat to learn

• Ho. to spell 2arrhythmia2

• -auses of and ris& factors for arrhythmia• %ecognition of the big four+ atrial fibrillation (3), heart bloc&, ventricular tachycardia (4") and

ventricular fibrillation (43)!

• "reatment protocols+ drugs, cardioversion, ablation, and defibrillation

Thromboembolic disease"his condition involves the pathological formation of thrombus and its acute complication of embolus,

especially to the pulmonary vasculature! Pulmonary embolus accounts for 15 of all hospital deaths! inetypercent of deep vein thromboses (4"s) occur in the deep veins of the lo.er limb!



$hat to learn

• 7nderstand 4ircho.2s triad and learn the specific ris& factors for thrombosis+ immobility, cardiac

failure, pregnancy, the combined oral contraceptive pill (-8-P), and varicose veins

• ymptoms and signs of 4" and pulmonary embolism (P9)

• -lassification of P9 from ma:or to minor and the emergency management of P9

• nticoagulation and its role in thromboembolic disease

Heart valve disorders

iseases of the heart valves produce t.o types of disorders, stenosis and regurgitation, .hich can coe;istin the same valve! 4alvular disease can be caused by damage to the valve leaflets or to the valve ring, or

can be secondary to damage to the papillary muscles or chordae! *mportant mechanisms includedegenerative calcification, rheumatic heart disease (the incidence of .hich is declining), and infective

endocarditis!

$hat to learn

• -oncentration on the big four+ mitral stenosis, mitral regurgitation, aortic stenosis, and aortic

regurgitation!

• ymptoms and signs of aortic and mitral valve disease!

• -auses, in particular calcification, endocarditis, and rheumatic heart disease!

• "ypes of valve replacement and the precautions necessary in patients .ho have replacements!

Peripheral vascular disease

Peripheral vascular disease is a common degenerative disease of the blood vessels, in particular of thearteries! *t results in a number of specific problems, including acute and chronic ischemia of the legs,

ischemia of the organs (e!g! &idneys, brain, bo.el), and aortic aneurysm! *t can be due to a number of

pathological processes, including arteriosclerosis and atheroma formation!

$hat to learn

• %is& factors for peripheral vascular disease+ smo&ing, hypertension, lipids, etc!

• echanisms of arteriosclerosis and atherosclerosis and the changes that occur in the artery .alls!

• *schaemia of the legs+ symptoms, signs and management!• ortic aneurysm+ definitions, diagnosis and treatment!

hronic obstructive pulmonary disease (!PD)

-hronic obstructive pulmonary disease is a common condition occurring in 1<5 of men and =5 of .omenbet.een the ages of ? and 6 years! *t could perhaps more correctly be called @chronic bronchitis and

emphysema@ because both conditions coe;ist in all patients .ith -8P, to varying degrees! 4irtuallyconfined to smo&ers, mortality from -8P is related to the number of cigarettes smo&ed per day!

$hat to learn

• iagnostic definitions clinical history for bronchitis and pathological for emphysema!

• ymptoms and signs, and the t.o subtypes of patient+ pin& puffers and blue bloaters!

• anagement of acute e;acerbations and longterm prophyla;is!• *nterpretation of arterial blood gas results!

Asthmasthma is a common chronic inflammatory condition of the air.ays that causes reversible obstruction! "he

air.ays are characteristically hyperresponsive to a .ide range of stimuli! 9dema, smooth muscle

hypertrophy, and mucous plugging cause obstruction!

$hat to learn



• -lassification into e;trinsic and intrinsic asthma, and the triggering, e;acerbating and relieving

factors

• tructural changes that occur in the air.ay, and their clinical features

• 9mergency management of acute asthma

• edical management of chronic asthma and inhaler techni#ue

"ung cancerBronchogenic carcinoma is the most common cause of death from cancer in the 7A, affecting 0,000

people per year! ales are affected more often than females, but an increasing incidence is occurring in

.omen! Pea& incidence is bet.een 0 and <0 years of age! "he 7A has the highest incidence of thisdisease in the .orld!

$hat to learn

• "he four main histological types+ s#uamous cell (?05), small cell (C05), adenocarcinoma (C05)

and large cell anaplastic (105)!

• %is& factors, clinical features and prognosis for each type!

• ymptoms and signs of pulmonary involvement, local spread, metastatic spread, and endocrine

and neurological syndromes!

• anagement and palliation!

PneumoniaPneumonia is defined as the consolidation of lung tissue caused by formation of intraalveolar

inflammatory e;udates as a result of a lung infection! "his must be visible on Dray to be properly called

pneumonia, as opposed to 2chest infection2! Pneumonia is the fifth most common cause of death,according to 7 data!

$hat to learn

• Predisposing factors to chest infection and pneumonia!

• -ommon causative organisms and the distinction bet.een communityac#uired and hospital

ac#uired pneumonia!

• iagnostic and pathological features of bronchopneumonia, lobar pneumonia and atypical

pneumonia!• "he special features of pneumonia in immunocompromised patients!

• ppropriate antibiotic use for the various types of pneumonia!

Pulmonary tuberculosis (T#)"his is a chronic granulomatous infection of the lung caused by ycobacterium tuberculosis! *t is

uncommon in the 7A, .ith an incidence of < per 100,000 per year, but is e;tremely common .orld.ide!Pulmonary "B is a very common e;am topic because of the increasing incidence in elderly,

immunocompromised, and homeless people, and the emergence of drugresistant strains!

$hat to learn

• %is& factors for infection and routes by .hich the organism can be spread!• Pathogenesis+ primary and secondary "BE the histopathological se#uence of events that leads to

granuloma formation!

• ymptom, signs and diagnosis of "B!

• onpulmonary "B!

• rug treatments for "B, public health measures to prevent spread and the problems of ensuring

compliance .ith treatment!

ystic fibrosis

-ystic fibrosis is a hereditary disease characteriFed by the production of abnormally thic& mucus due to



the presence of an abnormal transmembrane chloride ion transporter! *t primarily affects the lung andpancreas! *t is the most common autosomal recessive disorder, affecting 1 in C000 ne.borns! -ystic

fibrosis is a common e;am topic!

$hat to learn

• Pathogenesis+ learn the genetic and molecular mechanisms and the physiological effects that

produce the clinical features of the disease!

• ymptoms, signs and methods of diagnosis!

• Prognosis and management of the pulmonary and pancreatic effects of the disease!

Diffuse interstitial diseases (alveolitis)

"hese diseases comprise a group of noninfectious, nonmalignant disorders in .hich there is inflammationof the alveolar .alls .ith a thic&ening of the interstitium bet.een the alveoli, usually .ith fibrosis!

'earning about the features of the general disease process and one or t.o of the conditions in more detailis .orth.hile!

$hat to learn

• Histopathological changes for this general group of diseases, and management, .hich is similar for

all of them!

• ymptoms, signs and diagnostic features of interstitial diseases!

• "he three main causes of chronic pulmonary fibrosis+ (1) idiopathic (sarcoidosis and cryptogenicfibrosing alveolitis)E (C) dust inhalation, .hich might be inorganic (coal .or&ers2 pneumoconiosis)or organic (farmers2 lung)E and () iatrogenic (radiation pneumonitis or druginduced by

amiodarone or anticancer drugs)!

Pneumothora$

Pneumothora; is the presence of air in the pleural cavity! *t is common and can be spontaneous or causedby trauma! "he severity can range from mild to life threatening!

$hat to learn

• -auses of pneumothora;+ spontaneous (idiopathic or secondary to underlying disease) and

traumatic (accidental or iatrogenic)!• iagnosis and assessment of severity!

• anagement and ris&s of recurrence!

erebrovascular disease"his is the third most common cause of death in the 7A! tro&e is the common acute outcome of this

disease, but the disease can also cause a chronic multiinfarct dementia! "he incidence of stro&e in thegeneral population is C per 1000 per year, but it is actually much more common than this in the elderly!

$hat to learn

• -lassification and causes of cerebrovascular events!

• -linical features of stro&e and ho. they relate to the site of the lesion!

•

cute management of the stro&e patient!• %ehabilitation and prevention!

%pilepsy

eiFures are common in that 5 of the population have t.o or more seiFures during their lives! nepileptic seiFure is a convulsion or transient abnormal event that occurs due to the paro;ysmal discharge

of neurons! By definition, epilepsy is the continuing tendency to have such seiFures!

$hat to learn

• -lassification of epilepsy and prognostic features+ criteria for diagnosis!

• %is& factors and causes of epilepsy+ factors that might precipitate a seiFure!



• 9mergency management of status epilepticus!

• 'ongterm medical management .ith anticonvulsants!

&eningitisefined as inflammation of the meninges, this disease can be caused by bacterial, viral or, less commonly,

fungal and protoFoal infections! Bacterial meningitis is common and potentially life threatening if notdiagnosed and treated promptly!

$hat to learn

• -ausative organisms of meningitis!

• -linical features of bacterial meningitis and diagnosis!

• 9mergency management of bacterial meningitis and prophyla;is for contacts!

• 'ongterm complications!

Head in'ury"his is a common cause of acute admission to the hospital! ppro;imately C00 to 00 patients admitted

per 100,000 per year have head in:uries, and of these, roughly ?5 die from the in:ury! any more sufferlongterm disability as a result!

$hat to learn

• -auses and classification of head in:ury+ s&ull fracture, rupture of meningeal artery or dural veins!

• echanisms of brain damage+ direct neuronal damage, raised intracranial pressure, oedema,

ischaemia and hypo;ia!

• -linical features, diagnosis and management!

• 'ate se#uelae of head in:ury!

Headache

Headaches are very common causes of presentation! Headaches are commonly benign but canoccasionally indicate a serious underlying condition! detailed history is essential in deciding .hether to

reassure the patient or investigate further!

$hat to learn

• -auses and classification of headache!

• $hat to loo& for in the history that could signify a serious cause!

• cute management and prophyla;is of migraine headache!

• iagnostic features of subarachnoid hemorrhage

hronic pain-hronic pain is a common presentation in primary care! *t is a difficult problem to manage, and finding a

diagnosis can be a long process! lthough chronic pain is not a common e;am topic, you .ill fre#uently

have to deal .ith patients .ho have it!

$hat to learn

• -ommon causes and ris& factors for chronic pain!

• Psychological and social factors that might e;acerbate chronic pain!

• anagement options for chronic pain+ medical, surgical, psychological, and socialE don2t go into a

lot of detail but ensure that you &no. .hat is available!

Parinsons disease

Par&insonGs disease is a degenerative disease of dopaminergic neurons in the substantia nigra, .hichcauses an a&ineticrigid syndrome! *t is characteriFed by resting tremor, slo. voluntary movement, and



rigidity! Prevalence is 1 in 1000 of all adults, but rises to 1 in C00 in adults over 6? years of age!

$hat to learn

• 7nderlying mechanisms of the diseaseE in addition, learn about other causes for the par&insonian

syndrome (as opposed to the disease)!

• ymptoms, signs and diagnosis!

• edical management of Par&inson2s disease and sideeffects of primary treatment!

Al*heimers disease

lFheimerGs disease, a degenerative disease of the corte;, is the most common cause of dementia in$estern countries! *n the 7A it affects ?5 of people over 6? years of age, and 1?5 over the age of =0!

9tiology and pathogenesis are not fully understood, but characteristic histological changes and atrophy ofthe frontal lobes occur in patients .ith lFheimerGs disease!

$hat to learn

• -haracteristic histological features+ senile pla#ues, neurofibrillary tangles, and neuropil threads!

• e. genetic studies+ po9e genotype on chromosome 1 (often found in patients .ith

lFheimerGs disease)!

• -linical features of dementia!

• Ho. to perform a mental state e;amination!

• Prognosis and longterm management of lFheimer2s disease!

&ultiple sclerosis (&+)

ultiple sclerosis is the most common demyelinating disorder of the central nervous system (-)! *taffects ?0 per 100,000 in the 7A, and pea& incidence occurs bet.een C0 and 0 years of age! is

characteriFed by relapsing and remitting episodes of immunologically mediated demyelination in the -!

$hat to learn

• -urrent theories on etiology and pathogenesis+ association .ith human leu&ocyte antigen (H')!

• -linical features of !

• iagnostic tests+ computeriFed tomography (-") and magnetic resonance imaging (%*)E

cerebrospinal fluid (-3) e;amination for lymphocytes and oligoclonal bands!• edical management of !

&otor neuron disease

otor neuron disease is a progressive degenerative condition of motor neurons in the spinal cord, and ofthe somatic motor nuclei of the cranial nerves and the corte;! "he prevalence in the 7A is about 6 in

100,000, .ith onset mainly in the middle years of life! "he cause is un&no.n!

$hat to learn

• "he three main patterns+ progressive muscular atrophy, amyotrophic lateral sclerosis (') and

progressive bulbar palsy!

• -linical features of the three types of motor neuron disease!• iagnosis+ no specific tests e;istE diagnosis is made on clinical grounds alone!

• anagement options!

,astritis- gastroesophageal reflu$ disease (,!.D) and peptic ulcerationastrointestinal tract diseases include a spectrum of diseases comprising inflammation and ulceration of

the esophagus, stomach, or duodenum caused by mucosal damage due to particularly acidic gastric

secretions! *n the $est, 105 of the population e;perience * tract disease at some time in their lives!8% and ulcers normally develop in adulthood and follo. a history of repeated healing and relapse over

many years!

$hat to learn



• %is& factors, causative agents, and protective mechanisms, in particular the role of Helicobacter

pylori!

• ymptoms and signs of gastritis, gastroesophageal reflu;, and peptic ulcers!

• iagnostic tests in peptic ulcer disease!

• edical and surgical management!

Inflammatory bo/el disease (I#D)*nflammatory bo.el disease comprises a group of common disorders characteriFed by idiopathic

inflammation of the intestinal .all! -rohn2s disease and ulcerative colitis (7-) are the t.o most common

conditions! Prevalence in the 7A is 0 to ?0 per 100,000 for -rohn2s disease and =0 per 100,000 for 7-!either etiology is fully understood!

$hat to learn

• "he clinical and pathological features of 7- and -rohn2s diseaseE a common theme for #uestions is

to compare and contrast the t.o!

• "he complications and se#uelae of *B!

• "he systemic manifestations of *B!


iral hepatitis

"his is a common condition caused by a group of unrelated hepatotrophic viruses, all of .hich cause aprimary hepatitis or inflammation of the liver! -linical features are similar regardless of etiology! Hepatitis

viruses to are no. recogniFed and other, nonhepatotrophic viruses such as 9psteinBarr and

cytomegalovirus have also been &no.n to cause hepatitis!

$hat to learn

• "he characteristics and route of infection of hepatitis viruses to 9, .ith emphasis on B and -!

• ymptoms and signs of hepatitis, and diagnostic tests!

• "he presence of serum antibody and antigen for hepatitis B and - through the course of the

infection!

• ethods of treatment and immuniFation!

olorectal carcinoma

-olorectal carcinoma is an adenocarcinoma derived from glandular epithelium in the mucosa of the largebo.el! "his is the second most common cause of death from neoplasia in the 7A, .ith a pea& incidence

bet.een 60 and <0 years of age!

$hat to learn

• 9tiology and ris& factors for colorectal cancer!

• 7nderstand the progression from previous adenomas and the genetic model of successive

mutations that cause neoplasia!

• ymptoms, signs, and diagnosis!

• -lassification, staging, and grading!• ethods of treatment and prognosis!

!esophageal cancer

8esophageal cancer has an incidence of ?10 per 100 000 per year in the 7A! #uamous cell andadenocarcinoma are the most common types! Prognosis is usually poor because the disease is advanced

by the time symptoms arise!

$hat to learn



• etiology and ris& factors for oesophageal cancer! 7nderstand the concept of metaplasia in

Barrett2s oesophagus and ho. this can progress

• ymptoms and signs, diagnosis by gastroscopy

• anagement options and prognosis

,astric adenocarcinomaastric adenocarcinoma is a common cancer arising from the mucoussecreting epithelial cells in the

stomach! *ncidence is C0 to 0 per 100,000 per year in the 7A! *t is typically seen after the age of 0,.ith an increased incidence over ?0 years of age! "he male+female ratio is +C!

$hat to learn

• 9tiology and ris& factors for gastric cancer!

• "he geographical distribution!

• "he se#uence of genetic changes leading to neoplasia!

• -lassification of gastric cancers!


• urgical and medical management!

&alabsorption syndromesalabsorption disorders comprise a spectrum of disorders that produce symptoms of .eight loss,

abdominal distension, diarrhea .ith loose bul&y stool, steatorrhea, and anemia! echanisms includedisorders of intraluminal digestion by pancreatic enFymes, solubiliFation by bile acids, terminal digestion

by mucosal enFymes, and transepithelial transport!

$hat to learn

• "he physiological mechanisms involved in digestion and ho. they can fail in the various types of

malabsorption syndromes!

• -linical and pathological features of celiac disease and its treatment!

• Ano. an e;ample for each of the types of malabsorption mentioned above!

%sophageal cancer

9sophageal cancer has an incidence of ? to 10 per 100,000 per year in the 7A! #uamous cell andadenocarcinoma are the most common types! Prognosis is usually poor because the disease is advanced

by the time symptoms arise!

$hat to learn

• ymptoms and signs, diagnosis by gastroscopy!

• anagement options and prognosis!

• 7nderstand the concept of metaplasia in Barrett2s esophagus and ho. this can progress!

• 9tiology and ris& factors for esophageal cancer!

Diabetes mellitus

iabetes mellitus is a metabolic disorder, .hich presents as a spectrum of clinical disorders, .hich vary inseverity! *t is characteriFed by chronic hyperglycemia due to relative insulin deficiency! *t is common and

affects around 0 million people .orld.ide! *t is a large and important topic in medicine because of itsnumerous complications, .hich affect almost all parts of the body!

$hat to learn

• Have a reasonable overvie. of normal glucose metabolism!

• -lassification of diabetes mellitus types 1 and C!

• ymptoms, signs and diagnostic criteria!

• -omplications of diabetes+ cardiovascular, eyes, &idneys, neuropathy, feet, infections, s&in, and

:oints!



• 'ongterm management .ith diet, oral hypoglycemics, and insulin!

• iabetic emergencies+ &etoacidosis and hyperosmolar non&etotic coma!

• onitoring treatment!

!besity

common and increasing problem in the $est, obesity is defined as a body mass inde; (B*) above Cand is a ris& factor for a number of chronic illnesses, including hypertension, ischemic heart disease, and

diabetes!

$hat to learn

• B* and classification of obesity!

• ocioeconomic ris& factors for obesity!

• 'ongterm problems associated .ith obesity!

• anagement of obesity+ diet, e;ercise, medication and surgery!

Protein energy malnutrition

tarvation is a ma:or cause of morbidity and mortality .orld.ide! lthough not common in developedcountries, poverty, inappropriate diet, and coe;isting medical conditions, such as surgery, sepsis, cancer,

anore;ia nervosa and malabsorption syndromes, can produce degrees of starvation!

$hat to learn

• Pathophysiology of starvation+ understand carbohydrate, fat, and protein metabolism in the fed and

starved body states!

• -lassification and clinical features of proteinenergy malnutrition!

• ssessing the degree of malnutrition!

• "reatment+ resuscitation, refeeding, and rehabilitation!

Thyroid dysfunction"he metabolic activity of many tissues is regulated by the thyroid glandE over and underactivity of the

thyroid are the most common of all endocrine problems! Hypothyroidism can be caused by primary thyroid

disease or be secondary to hypothalamic or pituitary disease! Hyperthyroidism is nearly al.ays caused byintrinsic thyroid disease and affects C5 to ?5 of females at some time, .ith a female+male ratio of ?+1!

$hat to learn

• -auses and clinical features of hypothyroidism!

• *nvestigation and treatment of hypothyroidism!

• -auses and clinical features of hyperthyroidism!

• raves2 disease and thyroid eye disease!

• cute and longterm management of hyperthyroidism!

Adrenal dysfunction"he adrenal corte; secretes three main groups of steroid hormones+ glucocorticoids, mineralocorticoids,

and adrenal androgens! "hese have .ideranging effects throughout the body, and therefore the clinicalfeatures of adrenal dysfunction are comple;! -ushing2s syndrome is common, but the main cause is

iatrogenic through use of steroid therapy! ddison2s disease is rare but is a common topic for e;am#uestions!

$hat to learn

• ormal function of the adrenal a;is glucocorticoids and mineralocorticoids!

• *nvestigation and diagnostic tests in adrenal disease!

• -auses, clinical features, and management of -ushing2s syndromes!

• -auses, clinical features, and management of ddison2s disease!



• Hyperaldosteronism and -onn2s syndrome!

• Problems associated .ith corticosteroid therapy!

Parathyroid dysfunctionParathyroid hormone (P"H) is a polypeptide secreted by the chief cells of the parathyroid glands! *t acts

on the bones and &idneys to increase levels of serum calcium and decrease levels of serum phosphate!Primary hyperparathyroidism is the most common of the thyroid disorders and has a prevalence of 1 per

=00 in the 7A! 8ver 05 of patients are over ?0 years of age, and the female+male ratio is C+1!

$hat to learn

• 7nderstand the basics of normal calcium metabolism and the mechanisms by .hich P"H acts to

regulate calcium and phosphate

• -auses, clinical features, and management of primary hyperparathyroidism

• efinitions of secondary and tertiary hyperparathyroidism, and of renal osteodystrophy

• Hypoparathyroidism and clinical features of hypocalcemia

Pituitary tumorsPituitary tumors are the most common cause of pituitary disease! -linical features are the result of e;cess

hormone secretion, local effects of the tumor, or inade#uate hormone production by the remainder of thegland!

$hat to learn

• 7nderstand the normal function of the hypothalamus and pituitary!

• "he common tumor types and clinical syndromes that they cause+ prolactinoma, acromegaly,

-ushing2s disease, nonfunctioning tumors!

• iagnostic tests used in pituitary disease!

#ac pain

Bac& pain is an e;tremely common complaint, accounting for 65 of all eneral Practice consultations! *nthe 7A nearly 00,000 people lose time from .or& each year because of bac& pain! o cause .ill be found

in 05 of patients, but more serious problems, such as disc disease, spondylolisthesis, spinal stenosis,

and malignancy must be e;cluded!

$hat to learn

• Ho. to ta&e a good history of bac& pain and the important points (site, radiation, onset,

aggravating factors, and time pattern) that .ill lead to diagnosis!

• -linical features of the serious causes+ disc disease, spondylolisthesis, spinal stenosis, infection,

and malignancy!

• n approach to the management of psychogenic and nonspecific bac& pain!

!steoarthritis8steoarthritis is the most common type of arthritis, occurring in C05 of the population as a .hole and in

?05 of those over ?0 years of age! "his disease involves cartilage, .hich becomes eroded andprogressively thinned as the disease proceeds!

$hat to learn

• "he pathophysiological changes that occur in cartilage to cause the disease!

• ymptoms, signs, and ;ray findings in osteoarthritis!

• ifferentiation from other types of arthritis!

• anagement of osteoarthritis!

.heumatoid arthritis



%heumatoid arthritis is a common, chronic systemic disease characteriFed by a symmetrical inflammatorypolyarthritis that causes progressive :oint damage and disability in young people, and e;traarticular

involvement of lungs and other organs! *t affects about C5 of the population .orld.ide! $omen areaffected more often than men (+1), and there is an association .ith H'% in <05 of sufferers!

$hat to learn

• "he pathophysiological changes that occur in the synovium!

• ymptoms, signs, and ;ray changes in rheumatoid arthritis, especially features of the rheumatoid

hand!

• 9;traarticular complications!• iseasemodifying drugs for rheumatoid arthritis!

!steoporosis

8steoporosis is a common disorder in .hich a reduction in bone mass esists, includes all components ofthe bone, not :ust calcium, as in osteomalacia! 8steoporosis is a ma:or problem that .ill cause fractures in

05 of -aucasian .omen and C05 of men!

$hat to learn

• 9tiology and ris& factors for osteoporosis!

• -lassification into type 1 (postmenopausal) and type C (senile)!

• -linical features and diagnostic tests!• anagement and preventive measures!

+eptic arthritis"his results from infection of :oints .ith pyogenic organisms, the most common being taphylococcus

aureus, .hich can reach the :oint via the bloodstream, a local site of infection such as a boil, or

occasionally from an ad:acent site of osteomyelitis! eptic arthritis constitutes a medical emergency, andthe :oint can be ruined .ithin C hours .ithout treatment!

$hat to learn

• -linical features of septic arthritis!

• iagnostic approach+ :oint aspiration and blood cultureE ;rays are not useful!• anagement .ith antibiotics and sometimes drainage!

,out

"his is an abnormality of uric acid metabolism in .hich crystals of sodium urate become deposited in the :oints, soft tissue, and urinary tract! *t presents primarily .ith an acute arthritis, as .ell as tophi,

tenosynovitis, and urate &idney stones!

$hat to learn

• ormal uric acid metabolism and pathological mechanisms of urate crystal deposition!

• -linical features, ;ray, and :oint aspiration findings in gout!

• cute and prophylactic management of gout!

&yasthenia gravis"his is an ac#uired condition .ith a prevalence of in 100,000E it is t.ice as common in .omen as in

men! *t is characteriFed by .ea&ness and fatigue in pro;imal limb, ocular, and bulbar muscles! "heetiology is not fully understood but myasthenia gravis appears to be autoimmune, .ith immunoglobulin

(*g) antibodies to the acetylcholine receptor protein found in the serum! yasthenia gravis is a commone;am topic!

$hat to learn



• igns and symptoms of myasthenia gravis!

• iagnostic tests+ tensilon test and autoantibodies!

• -linical course of the disease and management!

+ystemic lupus erythematosus (+"%)

"his is the most common of the connective tissue diseases and is characteriFed by the presence ofantibodies against nuclear components! *t is a multisystem disease, .ith arthralgia and rashes the most

common clinical features, but vasculitis and disorders of the lung, heart, &idney, nervous system, and eyeand involvement of the * tract can all occur!

$hat to learn

• 9pidemiology and factors involved in pathogenesis, .hich is not fully understood!

• -linical features of '9!

• iagnostic findings!

• anagement and diseasemodifying therapy!

rinary tract infection (TI)7"*s are common infections in .omen but rare in men because of the longer urethra! %ecurrent or

untreated infection can cause considerable morbidity, including renal disease and endstage renal failure! 7"* is of particular significance in children because of the need for early diagnosis of abnormal urinary

tracts!

$hat to learn

• -ommon causative organisms and ris& factors for infection!

• ymptoms, signs and diagnosis!

• -omplications of 7"*s!

• anagement and further investigation (especially in children)!

#enign prostatic hypertrophy (#PH)

"his commonly occurs in men over the age of 60 years! "he etiology is not &no.n, but BPH ischaracteriFed by hyperplasia of the glandular and connective tissue in the prostate, resulting in

compression of the urethra and bladder outflo. obstruction!

$hat to learn

• ymptoms and signs of bladder outflo. obstruction, or 2prostatism2!

• iagnostic procedures!


Prostate cancer-arcinoma of the prostate is the fourth most common cause of death from malignancy in men in the 7A,

accounting for <5 of cancers in men! By the age of =0 years, =05 of men have malignant cells .ithin theprostate, although most remain dormant!

$hat to learn

• -linical features and diagnosis!

• "reatment .ith hormone analogues, radiotherapy, and surgery!

• Prognosis!

.enal and vesical calculi

bout C5 of the 7A population have a urinary tract stone at any given time! ost stones are composed of calcium o;alate and phosphate, but mi;ed infective stones are also common! *t is commonly a recurrent

problemE ?05 of patients .ill have formed a further stone .ithin 10 years!



$hat to learn

• 9tiology and ris& factors for the various types of stone!

• ymptoms, signs, and diagnostic tests!

• -onservative and surgical management of renal and vesical calculi!

.enal failure

"his term refers to the failure of renal e;cretory function due to depression of the glomerular filtrationrate! *t is often associated .ith failure of other renal functions+ acidbase balanceE regulation of salt,

.ater, and blood pressureE secretion of erythropoietinE and activation of vitamin !

$hat to learn

• efinitions of renal failure+ prerenal, renal, and postrenalE acute versus chronic renal failure!

• -auses of renal failure, .hich can be grouped into failure of renal perfusion, disease of the renal

vasculature, glomerulonephritis, and tubulointerstitial disease!


• anagement of endstage renal failure+ -ontinuous mbulatory Peritoneal ialysis (-P),

hemodialysis, transplant, and ancillary treatment (e!g! erythropoietin, calcium supplementation)!

Pregnancy

Pregnancy is obviously not a disease and is a huge topic in its o.n right, .ith muchassociated pathology!*t is included here as a reminder of the most important pregnancyrelated issues that students should

understand!

$hat to learn

• n overvie. of the developmental changes in the fetus through pregnancy and the physiological

adaptations in the mother!

• "he stages of pregnancy and labor!

• -omplications of pregnancy and parturition from early pregnancy (ectopic pregnancy and

miscarriage), late pregnancy (abruptionE placenta previaE preeclampsiaE Hemolysis, 9levated 'iver

transaminases, and 'o. platelets IH9''PJE gestational diabetesE cholestasis) to those of labor andbeyond (premature laborE instrumental and caesarean deliveryE postpartum hemorrhage)!

• rugs to be avoided during pregnancy and breastfeeding!

+ubfertility

"his is defined as the inability of a couple to conceive after 1 year of intercourse .ithout the use ofcontraception! *nfertility is a common problem and a cause of great distress! *n 05 to 05 of couples

there is an identifiable male factor, and in 05, a female tubal or ovarian cause e;istsE 1?5 of cases areidiopathic .ith no identifiable cause!

$hat to learn

• ale and female causes of subfertility!

• *nvestigations re#uired to investigate subfertility+ sperm count, laparoscopy, and dye studies!

• "echni#ues for assisted conception+ hormonal, in vitro fertiliFation (*43) and *ntracytoplasmicperm *n:ection (*-*)!

• %is&s associated .ith fertility treatment!

ontraception

"he aim of contraception is to prevent unplanned pregnancies! "he ideal contraceptive is effective,acceptable, safe, and reversible! -ontraception is a large and comple; topic that is e;tremely important in

primary care!

$hat to learn

• "he ma:or classes of contraceptives and the mechanisms by .hich they operate!



• Hormonal contraception+ indications, contraindications and sideeffects of the combined pill, the

progestogenonly pill, depot in:ections, implants, and emergency @morningafter@ pills!

• onhormonal contraception+ indications and contraindications of the assisted rhythm method

(using temperature or hormone testing &its), barriers (condom and diaphragm), intrauterine

devices!

• teriliFation!

Abnormal menstruationisorders of menstruation fall into three categories+ amenorrhea, dysmenorrhea (painful periods), and

dysfunctional uterine bleeding!

$hat to learn

• %efresh your memory of the hormonal control of the menstrual cycle and the physiological changes

that occur!

• -auses of primary and secondary amenorrhea, and the investigations indicated for each!

• -auses and management of dysmenorrhea often primary .ith no other abnormality foundE

sometimes secondary to endometriosis, adenomyosis, infection, or uterine polyps!

• -auses of dysfunctional uterine bleeding, and management!

%ndometriosis

9ndometriosis is a very common gynecological disorder that occurs in 1C5 of .omen, although not allhave symptoms! *t is caused by ectopic deposits of endometrial cells in the lo.er part of the peritoneal

cavity!

$hat to learn

• 9tiology and epidemiology of endometriosis!

• ites at .hich endometriotic deposits are most li&ely!

• ymptoms and signs of endometriosis, and methods of diagnosis!

• Hormonal and surgical management!

The menopause and hormone replacement therapy (H.T)"he menopause, or cessation of periods, occurs naturally bet.een the ages of ? and ?? years, .ith the

mean age of onset currently years in the 7A! ost .omen notice irregular scanty periods for a variable

period before symptoms of estrogen deficiency begin!

$hat to learn

• Hormonal changes that occur in the menopause

• igns and symptoms of the menopause

• 'ongterm ris&s involved in early menopause

• H%" methods available, ris&s and benefits

#reast cancer

"his comprises C05 of all cancers in .omen and is the most common cause of death in the ? to ??yearage group! *ncidence is higher in the $est than in developing countries!

$hat to learn

• 9tiology and predisposing factors for breast cancer!

• -lassification of neoplastic breast disease+ ductal and lobular carcinomaE staging and grading of

breast cancer!


• "reatment and prognosis!

• creening for breast cancer!



ervical cancer"he vast ma:ority of cervical carcinomas are s#uamous cell in origin! *ncidence is =00 ne. cases per year

in 9ngland and $alesE mortality is 1000 per year! *t occurs from the teens on.ard, but the average age ofonset is ?0 years! *t is preceded by the preinvasive phase of cervical intraepithelial neoplasia (-*)!

$hat to learn

• 9tiology and ris& factors for -*!

• -lassification and progression of -*!

• -ervical screening!• -linical features and diagnosis of cervical cancer!


!varian cancer

"his is responsible for more deaths than any other gynecological malignancy over 000 per year in the7A because it is usually advanced on presentation! Primary ovarian cancers account for ?5 of

malignancies in .omen! eventy percent are surface epithelial tumorsE C05 are germcell in origin, andthe remaining 105 are se;cord and stromal tumors!

$hat to learn

• -lassification of ovarian tumor types and clinical features!• ymptoms, signs, and diagnostic tests for ovarian carcinoma!

• "reatment of ovarian cancer!

Impotence

"his is the inability of the male to achieve or sustain an erection ade#uate for satisfactory intercourse! *t isa common problem, but many patients have no definable organic cause! "rue erectile difficulty can be

psychological, vascular, or endocrine or drug related!

$hat to learn

• -auses of impotence!

• edical and psychological methods of managing impotence!

Testicular cancer

"umors of the testis are uncommon, affecting 15 to C5 of men, but are important because of their earlyage of onset and good response to chemotherapy! inetyseven percent of cases are germcell tumors

(seminomas or teratomas), and the rest are derived from the support cells of the testis ('eydig andertolicell tumors, lymphoma) and metastatic deposits!

$hat to learn

• ymptoms and signs of testicular cancer!

• -lassification of testicular tumor types and clinical features!


&enopause and hormone replacement therapy (H.T)

"he menopause, or cessation of periods, occurs naturally bet.een the ages of ? and ?? years, .ith themean age of onset currently ?1 years in the 7A! ost .omen notice irregular scanty periods for a variable

period before symptoms of estrogen deficiency begin!

$hat to learn

• igns and symptoms of the menopause!

• Hormonal changes that occur in the menopause!



• 'ongterm ris&s involved in early menopause!

• H%"+ methods available, ris&s, and benefits!

Anemia

nemia is a state in .hich the level of hemoglobin in the blood is belo. the normal range for the patient2sage and se;+ 1!?1=!0 g/d' in males and 11!?16!0 g/d' in females! -auses are numerous and can be

divided roughly into three categories+ (1) reduced production of hemoglobin or red blood cellsE (C)

increased red cell destructionE or () blood loss (acute or chronic)!

$hat to learn

• "he causes of anemia as outlined above!

• ymptoms and signs of anemia!

• *nvestigations to find the cause of anemia!

+icle2cell diseaseic&lecell disease is a common inherited disease caused by a point mutation in the beta globulin gene,

.hich results in the substitution of valine for glutamate! "he resultant hemoglobin variant, Hb,polymeriFes at lo. o;ygen saturations, causing the characteristic sic&le deformity of the red cells, .hich

2sludge2 in the small vessels and undergo hemolysis!

$hat to learn

• 9pidemiology and pathophysiology of sic&lecell disease+ association .ith malariaendemic regions!

• -lassification of sic&lecell disease+ heteroFygous and homoFygous forms!

• -linical features of sic&lecell disease!

• anagement of sic&lecell crises!

"euemia

'eu&emia includes a spectrum of diseases caused by malignant proliferation of hemopoietic precursor cells

in the bone marro.! "hese diseases are not commonE the incidence is ? per 100,000 per year for alltypes, but they are important because of their responsiveness to treatment!

$hat to learn

• -lassification of the four main types+ acute lymphoblastic, acute myeloblastic, chronic lymphocytic

and chronic myeloidE be a.are of the subclassification .ithin these main types (3rench mericanBritish (3B) etc!)!

• 9tiological factors+ especially genetic mutations such as the Philadelphia chromosome and the

translocation!

• ymptoms and signs of leu&emia!

• iagnostic tests (blood film, bone marro. biopsy, and cytogenetics)!

• anagement of leu&emia+ chemotherapy ranulocyte, onocyte-olony timulating 3actor (

-3) and (ll"rans %etinoic cid ("%), and supportive treatment (i!e!, blood transfusions)!

"ymphoma"he lymphomas are caused by neoplastic proliferation of cells in the lymphoid system! -lassification is

based on histological appearance of the abnormal cells and is divided into Hodg&in2s and nonHodg&in2slymphoma (H')!

$hat to learn

• -lassification of the lymphomas and ho. the disease is staged and graded!


• differential diagnosis of causes of lymph node enlargement!

• Prognosis and management of lymphoma!



&yelomayeloma is a disease caused by malignant proliferation of plasma cells in the bone marro.! *t is part of a

spectrum of diseases characteriFed by the presence of a serum paraprotein that can be demonstrated as amonoclonal band on electrophoresis! *t occurs mainly in people over ?0 years of age! "he clinical features

are caused by bone destruction, bone marro. infiltration and failure, and renal failure due to deposition of the light chain paraprotein!

$hat to learn

• Pathophysiology of the disease and mechanisms by .hich the clinical features are produced!• ymptoms, signs, and diagnostic tests+ blood film, protein electrophoresis, BenceKones proteins in

urine, and bone marro. biopsy in particular!

• Prognosis and management!

Hemophilia AHemophilia is an Dlin&ed recessive inherited disease characteriFed by a deficiency of clotting factor 4***!

"he incidence is 1 in <?00 of the male population per year! -linical features depend on the level of factor4***+ if it is less than 15 of normal, the patient .ill e;perience fre#uent spontaneous bleeds from early

life! Bleeds commonly occur into the large :oints (hemarthroses) and lead to crippling deformity if thecondition is untreated!

$hat to learn

• 7nderstand the clotting path.ay and ho. factor 4*** plays a central roleE ensure that you are

learning the uptodate version and not the old intrinsic/e;trinsic model!

• -lassification of the severity of hemophilia, and clinical features!

• anagement of hemophilia+ factor 4***, activated factor 4**, 1deamino=arginine vasopressin,

also &no.n as desmopressin (dd4P), and potential for gene therapy!

• %is&s of treatment .ith blood products and the effects of human immunodeficiency virus (H*4) and

hepatitis - infection in people .ith hemophilia!

Depression

epression is a very common mood disorder that affects 1=5 of the population at some point in their

lives! 3emales are at greater ris& than males, .ith the female+male ratio C+1! first episode can occur atany age, .ith the mean onset being in the late 0s!

$hat to learn

• 9tiology and ris& factors for depression!

• -lassification and diagnostic criteria for depressive illness!

• ental state e;amination and assessment of suicide ris&!

• "reatment of depression+ medical, psychological, electroconvulsive therapy (9-")!

+chi*ophrenia

chiFophrenia is a common psychiatric illness characteriFed by disorders of thought and perception and

leading to psychotic symptoms and social .ithdra.al! "here is a lifetime prevalence of about 15 .ith nogender bias! ge of onset pea&s at 1? to C? years of age for males and C? to ? years of age in .omen!

$hat to learn

• %is& factors and epidemiology!

• -lassification and diagnostic criteria for schiFophrenia!

• %is& assessment+ harm to self, harm to others, ris& of e;ploitation!

• edical and psychological management, and prognosis!

#ipolar affective disorder



Bipolar affective disorder is a mood disorder characteriFed by cyclical instability of mood, .hich can varybet.een depressive and manic states over time! 'ifetime prevalence is about 15 .ith no gender bias!

$hat to learn

• 9tiology and ris& factors!

• -lassification and diagnostic criteria!

• anagement .ith antidepressants, mood stabiliFers, and psychological methods!

An$iety disorders

"hese comprise a spectrum of disorders that include generaliFed an;iety disorder, panic attac&s, phobias(agoraphobia, social phobia, and specific phobias), obsessivecompulsive disorder (8-), and post

traumatic stress disorder!

$hat to learn

• 9tiology, epidemiology, and ris& factors for an;iety disorders!

• iagnostic criteria for an;iety disordersE focus on 8- and phobias for more specific symptoms!

• anagement .ith medication and psychological approaches, in particular cognitive behavioral

therapy (-B")!

Addiction

lcohol and substance dependence is a comple; and common problem involving medical, psychological,and social disciplines in its management!

$hat to learn

• 9tiology and ris& factors for alcohol and substance addiction!

• cute management of alcohol and drug .ithdra.al and into;ication!

• edical and psychological complications of alcohol and drug addiction!

• 8ptions for treatment!

%ating disordersnore;ia nervosa and bulimia nervosa are predominantly diseases of young -aucasian .omenE the se;

bias is 10+1 female to male! nore;ia has a prevalence of 0!C5 to 15 in adolescent females, .hereasbulimia is more common and has a prevalence of 1!? to C!?5! 9ating disorders are associated .ith

disorders of selfesteem and body image!

$hat to learn

• iagnostic criteria for anore;ia and bulimia nervosa!

• anagement of eating disorders!

• edical complications of the eating disorders and indications for hospitaliFation!

Premature birth neonate born before gestational age of < .ee&s is @preterm,@ or @premature!@ 3ive percent of

pregnancies end in spontaneous preterm delivery, and <05 of all perinatal deaths occur in preterminfants, especially if they are gro.th retarded! "he cause of premature birth is often un&no.n, but there

are a number of ris& factors!

$hat to learn

• 9tiology and ris& factors for preterm delivery!

• -omplications and morbidity associated .ith preterm and lo. birth.eight infants!

• anagement of the preterm neonate both before and after delivery!

#ronchiolitis



Bronchiolitis is a very common cause of pediatric admissions! uring the .inter, @bronchiolitis season@patients can fill all the beds on the .ard! *t is caused by the respiratory syncytial virus (%4) and is most

serious in infants and young children up to years of age! -hildren .ho have bronchiolitis present .ithfever, respiratory distress, and a secondary failure to feed! "reatment is supportive .ith o;ygen and

nasogastric or intravenous hydration if necessary!

$hat to learn

• 9tiology and epidemiology of %4 infection!

• ymptoms, signs, and diagnosis of bronchiolitis!

• anagement of bronchiolitis!

roupcute laryngotracheobronchitis, also &no.n as LMcroup@, is a common and potentially dangerous

complication of upper respiratory tract infection in children, especially those under years of age! "hemost common cause is parainfluenFa virus infection! *nflammatory edema of the vocal cords and epiglottis

causes narro.ing of the air.ay, .hich produces the characteristic cough and stridor!

$hat to learn

• 9tiology and epidemiology of croup!

• ymptoms, signs and differential diagnosis!

• cute management of croup!

erebral palsy"his term describes disorders apparent at birth or in childhood that are a result of brain in:ury in the

neonatal period! "his in:ury results in a nonprogressive neurological deficit! "he precise cause can bedifficult to determine, but common factors include hypo;ia in utero or during birth, trauma, prolonged

convulsions or coma, &ernicterus, and cerebral hemorrhage or infarction!

$hat to learn

• 9tiology and ris& factors for cerebral palsy!

• -lassification of cerebral palsy and clinical features!

• 9nsure that you can recogniFe and correctly name the gait disorders, .hich are common in clinicale;ams!

3ailure to thrive

"his is a common presentation .ith primary care and pediatric outpatients! child2s .eight, height, or

head circumference persistently falls belo. the e;pected percentiles .hen plotted against the standardgro.th curves! "here are numerous causesE ho.ever, ?5 of cases are due to insufficient or problematic

feeding! 8ther causes include chronic infection and gastrointestinal or metabolic disease! any cases aresimply due to idiosyncratic gro.th pattern or parents of short stature!

$hat to learn

•

9tiology and ris& factorsE a differential diagnosis for failure to thrive!• "he diagnostic tests that can be employed!

• trategies for management of failure to thrive!

hild abuse

adly, this is a common problem and a difficult one to tac&le as a clinician! *t is important to recogniFe the

signs of child abuse and to &no. the correct .ay to proceed if you suspect it!

$hat to learn

• %is& factors for child abuse!

• %ecogniFing signs of child abuse!



• "he multidisciplinary approach to child abuse!

• Protocols for dealing .ith a suspected case+ as a :unior doctor this invariably starts .ith calling

your registrar or consultantE don2t try to handle it on your o.n!

Human Immunodeficiency irus (HI) disease4Ac5uired Immune Deficiency +yndrome (AID+)c#uired immune deficiency syndrome is caused by infection .ith the H*4 retrovirus! *t currently affects

over 0 million people .orld.ide and is granted additional prominence because of its high media profile!

$hat to learn

• "he structure and characteristics of the H*4 retrovirus!• 9tiology, epidemiology, and clinical course of H*4 infectionE monitoring the disease (- count,

etc!)!

• igns and symptoms of * and *related comple;+ the presentations of the common

opportunistic infections and tumors!

• anagement of H*4 disease+ antiretroviral therapy, treatment, and prophyla;is against

opportunistic infections!

• ocial and psychological aspects of H*4 disease!

&alaria"his protoFoal infection affects C<0 million people .orld.ide each year and has a mortality rate of 15!

9ndemic and epidemic malaria are found in all countries bet.een the latitudes 0N south and 0N north!"he disease is caused by four species of protoFoa+ Plasmodium falciparum, P. vivax , P. ovale and P.

malariae!

$hat to learn

• "he lifecycle of the Plasmodium parasites in the nopheles mos#uito (the definitive host) and

humans (the intermediate host)!

• ymptoms, signs and diagnostic tests for malaria!

• "he clinical course of the disease and complications!

• cute management of malarial infection!

• ntimalarial prophyla;is!

holera-holera is a common disease .orld.ide that is caused by the gramnegative bacillus Vibrio cholerae, for

.hich humans are the only host! *t is transmitted by the fecooral route, and contaminated .ater supply is

the ma:or factor in the spread of the disease! "he classic feature is painless, profuse, .atery diarrhea,.hich can cause death by dehydration and electrolyte imbalance if untreated!

$hat to learn

• 9tiology and epidemiology of cholera!

• -haracteristics of V. cholerae and the to;ins it produces!

• -linical course of the disease and its diagnostic features!

• edical and public health management of the disease!

Immuni*ation*mmuniFation is another important topic for e;ams and primary care! onitoring and prescribing

immuniFation can be a significant part of your .or&load in practice!

$hat to learn

• %efresh your &no.ledge of the principles of immuniFation!

• "ypes of vaccine+ live attenuated, inactivated, and recombinant, and the merits and disadvantages

of each type!

• -urrent childhood immuniFation policy!



%c*ema and dermatitisermatitis implies inflammation of the s&in, and the term is often used interchangeably .ith ecFema!

-haracteristic features are hot, red s&inE edema in the acute stagesE .eeping and ooFingE e;coriationEsecondary infection and impaired thermoregulation in severe cases!

$hat to learn

• -lassification and patterns of ecFema+ atopic/endogenous, pompholy;, e;ogenous, and discoid!

• 9tiology and histological changes in ecFema!

• -linical and diagnostic features of ecFema!

• "reatment!

PsoriasisPsoriasis is a chronic s&in disease seen commonly as erythematous, .elldemarcated, silveryscaled

pla#ues over e;tensor surfaces! *t affects C5 of the population in temperate countries! rthropathy isassociated .ith the s&in disease in =5 to105 of cases!

$hat to learn

• 9tiology and epidemiology!

• -linical and diagnostic features, and patterns of psoriasis!

• "reatment of psoriasis!

Pemphigus and pemphigoid

"hese bullous disorders are rare but commonly crop up in e;ams! Both disorders are associated .ithautoimmune antibody deposition in the epidermis! "he depth at .hich this occurs relates to the clinical

features observed!

$hat to learn

• 9tiology and epidemiology of Pemphigus vulgaris and pemphigoid!

• -linical features of the t.o diseases+ be able to compare and contrast them!

• "reatment and prognosis for each condition!

%rythema multiformen acute and selflimiting condition, erythema multiforme affects the s&in and mucosal surfaces! 'esions

are typically concentric rings of papules, especially on the hands, forearms, and feet! 9rythema multiformeis associated .ith herpes simple; and mycoplasma infections, drug reactions, connective tissue disease,

and neoplasia! *mmune comple; deposition in the s&in seems to play a role! "his topic commonly appearson e;ams!

$hat to learn

• 9tiology and associated conditions!

• -linical and diagnostic features!

• "reatment, especially of tephensKohnson syndrome, .hich can be lifethreatening!

%rythema nodosum

"his is an acute condition characteriFed by painful nodules on the shins and occasionally on the thighs andarmsE it is most common in adult females! "here are many causes, including drugs, sarcoidosis, *B,

infection, and pregnancyE no cause .ill be found in ?05 of cases! *t is not a common condition but is afavorite e;am topic because of the variety of causes!

$hat to learn

• "he causes and clinical features of erythema nodosum!

• *nvestigations to e;clude serious causes!



• "reatment+ usually conservative .ith nonsteroidal antiinflammatory drugs (*s)E condition

usually resolves in a fe. .ee&s!

+in cancer

"he three most important malignancies of the s&in are basal cell carcinoma, s#uamous cell carcinoma, and

malignant melanoma! ll three types are associated .ith sun damage! Basal cell carcinoma is locallyinvasive, but metastasis is rare, .hereas at the other end of the scale, malignant melanoma is highly

aggressive, and the prognosis is poor if the melanoma is not treated early!

$hat to learn

• 9tiology, epidemiology, and ris& factors for the three types of cancer!

• -linical and diagnostic features!

• taging and prognosis for malignant melanoma!

• anagement options+ surgical e;cision and radiotherapy!

Acute abdomen

cute abdomen is most commonly a surgical presentation, rather than being a disease in itself! *t isimportant to have a clear approach to the assessment and management of this condition!

$hat to learn

• "he differential diagnosis of an acute abdomen!• ymptoms and signs of peritonitis!

• "he diagnostic approach and investigations re#uired!

• *nitial management!

Appendicitisppendicitis is a common surgical problem that can present at any age but .ith a pea& incidence in the

teen years and early adulthood! iagnosis can be problematic because classic symptoms occur in only

??5 of cases!

$hat to learn

• 9tiology of appendicitis, and vulnerable groups!• ymptoms, signs, and differential diagnosis of appendicitis!

• -linical course of the disease!

• anagement of acute appendicitis!

Diverticular disease"his is a very common condition in the $est and is caused by lac& of dietary fiber! *t affects t.othirds of

the population by the age of <0 years and is more common in .omen than men (+C)! any cases areasymptomatic, and the most common symptom on presentation is abdominal pain!

$hat to learn

• 9tiology and ris& factors for diverticular disease!• efinitions of diverticular disease+ diverticulosis, diverticulitis!

• ymptoms, signs and differential diagnosis!

• -linical features and complications!

• -onservative and surgical management!

Pancreatitis

"his occurs in 10 to C0 per 100,000 people per year in the 7A! ost cases of acute pancreatitis are causedby gallstones or alcohol! Pancreatitis is a potentially lifethreatening condition .ith an overall mortality of

=5 to 105!



$hat to learn

• 9tiology and ris& factors for pancreatitis!


• %anson2s criteria for assessment of severity, and clinical course of the disease!

• anagement of acute pancreatitis!

"arge bo/el obstruction

"his is a common cause of an acute abdomen and is characteriFed by the symptoms and signs of

abdominal pain, distension, vomiting, and inability to pass stool or flatus! -ommon causes include simpleconstipation, cancer of the colon, diverticular stricture, and sigmoid volvulus!

$hat to learn

• ymptoms, signs, and differential diagnosis of large bo.el obstruction!

• iagnostic investigations!


holecystitis

allstones are very common, but only a small minority of adults .ith gallstones develop acutecholecystitis, .hich in ?5 of cases is due to the impaction of a gallstone in Hartmann2s pouch!

$hat to learn

• etiology and ris& factors for gallstones the 32s (3at, 3ertile 3emales)!

• ymptoms and signs of acute cholecystitis!

• -linical course and diagnosis of acute and chronic cholecystitis!

• -onservative, endoscopic and surgical management!

Hernia hernia is the abnormal protrusion of a viscus, or of part of a viscus, through the coverings that contain

it! *ncisional hernias are the most common type, follo.ed by inguinal, femoral, and finally, umbilical

hernias! *nguinal hernia occurs in 15 to C5 of children, mostly boys (+1), and in 11C per 100,000 adultsper year in the 7A! "he ratio of inguinal to femoral hernias is 0+1 in men and +1 in .omen!

$hat to learn

• "he anatomy of the inguinal and femoral canals, and etiology of hernias!

• -lassification of hernias by location, type, and severity!

• ymptoms, signs, and differential diagnosis for the above types of hernia!


• %efresh your &no.ledge of the regional anatomy!

• %is& factors for testicular torsion!

• urgical management!

Testicular torsion"esticular torsion is an acute and painful condition caused by rotation of a testis on its mesentery, so that

blood supply is impaired, resulting in ischemic pain and edema! *t is a surgical emergency, and the torsionmust be corrected .ithin hours to save the testis! *t occurs at any age but most often during adolescence!

$hat to learn

• 9tiology and ris& factors for testicular torsion!

• ymptoms, signs, and classification of testicular torsion!

• urgical management, and prognosis!



HemorrhoidsHemorrhoids constitute a common problem caused by hypertrophy of vascular cushions of tissue at the

anal margin! *t is a condition of midtolate adulthoodE half of all patients are over the age of ?0!ymptoms are rectal bleeding, prolapse, pain, mucous discharge, and prutitus ani!

$hat to learn

• ymptoms, signs, and classification of hemorrhoids!

• -onservative and surgical management, and prognosis!

• 9tiology and ris& factors for hemorrhoids!

Usmle Top 100 Diseases

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Transcript of Usmle Top 100 Diseases