IMPORTANT POINTS…
Here is a list of commonly tested facts in MRCP Part 1 exam also for FCPS… They are listed in order of importance - highest first.
-
Acromegaly – Diagnosis: OGTT followed by GH conc.
-
Cushings – Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen.
-
Rash on buttocks – Dermatitis herpetiformis (coeliac dx).
-
AF with TIA --> Warfarin. Just TIA’s with no AF --> Aspirin
-
Herpes encephalitis --> temporal lobe calicification OR temporoparietal attentuation – subacute onset i.e. Several days.
-
Obese woman, papilloedema/headache --> Benign Intercanial Hypertention.
-
Drug induced pneumonitis --> methotrexate or amiodarone.
-
chest discomfort and dysphagia --> achalasia.
-
foreign travel, macpap rash/flu like illnes --> HIV acute.
-
cause of gout --> dec urinary excretion.
-
bullae on hands and fragule SKIN torn by minor trauma --> porphyria cutanea tarda.
-
Splenectomy --> need pneumococcal vaccine AT LEAST 2 weeks pre-op and for life.
-
primary hrperparathyroidism --> high Ca, normal/low PO4, normal/high PTH (in elderly).
-
middle aged man with KNEE arthritis --> gonococcal sepsis (older people -> Staph).
-
sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome benign, no Rx needed.
-
TREMOR postural,slow progression,titubation, relieved by OH->benign essential TREMOR AutDom. (MS – titbation, PD – no titubation)
-
electrolytes disturbance causing confusion – low/high Na.
-
contraindications lung Surgery --> FEV dec bp 130/90, Ace inhibitors (if proteinuria analgesic induced headache.
-
1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance angiogram.
-
temporal tenderness–> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion.
-
severe retroorbital, daily headache, lacrimation --> cluster headache.
-
pemphigus – involves mouth (mucus membranes), pemphigoid – less serious NOT mucosa.
-
diagnosis of polyuria -> water deprivation test, then DDAVP.
-
insulinoma -> 24 hr supervised fasting hypoglycaemia.
-
Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT.
-
causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig, lymphoma, trop sprue (rx tetracycline).
-
diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets.
-
hepatitis B with general deterioration -> hepaocellular carcinoma.
-
albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis).
-
HBSag positive, HB DNA not detectable --> chornic carier.
-
Inf MI, artery invlived -> Right coronary artert.
-
Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, FAMILIAL hyperchol,Gilberts, Huntington’s, Marfans’s, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers.
-
X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B.
-
Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR.
-
Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2.
-
HOCM/MVP - inc by standing, dec by squating (inc all others). HOCM inc by valsalva, decs all others. Sudden death athlete, FH, Rx. Amiodarone, ICD.
-
MVP sudden worsening post MI. Harsh systolic murmur radites to axilla.
-
Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia.
-
Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy, radiotherapy, toxins.
-
Tumor compressing Respiratory tract --> investigation: flow volume loop.
-
Guillan Barre syndrome: check VITAL CAPACITY.
-
Horners – sweating lost in upper face only – lesion proximal to common carotid artery.
-
Internuclear opthalmoplegia: medial longitudinal fasciculus connects CN nucleus 3-4. Ipsilateral adduction palsy, contralateral nystagmus. Aide memoire (TRIES TO YANK THE ipsilateral BAD eye ACROSS THE nose ). Convergence retraction nystagmus, but convergence reflex is normal. Causes: MS, SLE, Miller fisher, overdose(barb, phenytoin, TCA), Wernicke.
-
Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal dolls eye . i.e. Occulomotor nuclei intact, supranuclear Pathology .
-
Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS.
-
demetia, gait abnormaily, urinary incontinence. Absent papilloedema–>Normal pressure hydrocephalus.
-
acute red eye -> acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcleritis, subconjuntival haemmorrhage).
-
wheeles, URTICARIA , drug induced -> aspirin.
-
sweats and weight gain -> insulinoma.
-
diagnostic test for asthma -> morning dip in PEFR >20%.
-
Causes of SIADH : chest/cerebral/pancreas Pathology , porphyria, malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs, rifampicin, opiates)
-
Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma Nephrogenic: Lithium, amphoteracin, domeclocycline, prologed hypercalcaemia/hypornatraemia, FAMILIAL X linked type
-
bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vitamin D also).
56.returned from airline flight, TIA-> paradoxical embolus do TOE. -
alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff.
-
mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute.
-
painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven otherwise
60 late complication of scleroderma --> pumonaryhypertention plus/minus fibrosis. -
causes of erythema mutliforme: lamotrigine
-
vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically abnormal in this setting DO NOT give thyroxine).
-
mouth/genital ulcers and oligarthritis -> behcets (also eye /SKIN lesions, DVT)
-
mixed drug overdose most important step -> Nacetylcysteine (time dependent prognosis)
-
cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling, conj injectn
-
asymetric parkinsons -> likely to be idiopathic
-
Obese, NIDDM female with abnormal LFT’s -> NASH (non-alcoholic steatotic hepatitis)
-
fluctuating level of conciousness in elderly plus/minus deterioration --> chronic subdural. Can last even longer than 6 months
-
Sensitivity --> TP/(TP plus FN) e.g. For SLE - ANA highly sens, dsDNA:highly specific
-
RR is 8%. NNT is ----> 100/8 --> 50/4 --> 25/2 --> 13.5
-
ipsilateral ataxia, Horners, contralateral loss pain/temp --> PICA stroke (lateral medulary syndrome of Wallenburg)
-
renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric acid and cyteine stone are radioluscent.
-
hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Da antags (metoclopramide, chlorpromazine, cimetidine NOT TCA’s), pregnancy, PCOS, pit tumor/microadenoma, stress.
-
Distal, asymetric arthropathy -> PSORIASIS
-
episodic headache with tachycardia -> phaeochromocytoma
-
very raised WCC -> ALWAYS think of leukaemia.
-
Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT bone marrow
-
Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at diagnosis.
-
pancytopenia with raised MCV --> check B12/folate first (other causes possble, but do this FIRST). Often associayed with phenytoin use --> decreased folate
-
miscariage, DVT, stroke --> LUPUS anticoagulant --> lifelong anticoagulation
-
Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
-
anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic hypogonadism)
-
diag of PKD -> renal US even if think anorexia nervosa
-
commonest finding in G6PD hamolysis -> haumoglobinuria
-
mitral stenosis: loud S1 (soft s1 if severe), opening snap… Immobile valve -> no snap.
-
Flank pain, urinalysis:blood, protein -> renal vein thrombosis. Causes: nephrotic syndrome, RCC, amyloid, acute pyelonephritis, SLE (atiphospholipid syndrome which is recurrent thrombosis, fetal loss, dec plt. Usual cause of cns manifestations assoc with LUPUS ancoagulant, anticardiolipin ab)
-
anaemia in the elderly assume GI malignancy
-
hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)
-
pain, numbness lateral upper thigh --> meralgia paraesthesia (lat cutaneous nerve compression usally by by ing ligament)
-
diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrin saturation, genotyping. If nondiagnostic do liver biopsy 0.3% mortality
-
40 mg hidrocortisone divided doses (bd) --> 10 mg prednisolone (ie. Prednislone is x4 stronger)
-
BTS: TB guidlines – close contacts -> Heaf test -> positive CXR, negative --> repeat Heaf in 6 weeks. Isolation not required.
-
Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity.
-
Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles ->>Discoid LUPUS
-
wt loss, malabsoption, inc ALP -> pancreatic cancer
-
foreign travel, tender RUQ, raised ALP --> liver abscess do U/S
-
wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoea does NOT have to be present)
-
haematuria, proteinuria, best investigation --> if glomerulonephritis suspected --> renal biopsy
-
venous ulcer treatment --> exclude arteriopathy (eg ABPI), control oedema, prevent infection, compression bandaging.
-
Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West Africa) longer imcubation.
-
Fever, lymphadenopathy, lymphocytosis, pharygitis —>EBV —> heterophile antibodies
-
GI bleed after endovascular AAA Surgery --> aortoenteric fistula
-
Young girl – suspect Anorexia Nervosa – linugo hair, finctional hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually normal. Ferritin low.
-
Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Yersinia, SALMONELLA , Shigella. Balanisits.
-
PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
-
Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis
-
heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
-
Vitiligo – commonest assoctions pernicious anaemia >>> type 1 DM , autoimmune addisons, autoimmune thyoid dx
-
Gout – blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute phase
-
Peripheral neuropathy – a) B12 – rapid, dorsal columns (joint pos, vibration), sensory ataxia, pseudoathetosis of upperlimbs b) diabetic – slow, spinothalamic (pain, temp?) c)alcohol – slow progressive, spinothalamic d) Pb – motor upper limbs
-
CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML – demylination in advanced HIV, low attenuation lesions)
-
Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), SALMONELLA (serious systemic illness), E.coli (rx. Ciprofloxacin) , Shigella
-
Renal syndrome – minimal change disease, membanous, IgA nephropathy, post-streptococcal.
-
If you see blood on urinalysis forget about RAS
-
Thyroid Malignancy – tend to be non-functional, anaplastic has worse prognosis, local infiltration -> dysphagia, vocal cord paralysis
117.ALMOST Pathognomic for the exam
fatiguability -> myasthenia gravis
fasciculations -> Motor neurone diease
silvery white scale -> PSORIASIS
hypopigmented -> vitiligo/pityriasis versicolor
pretibial myxoedema --> Graves (NOT lid lag, NOT exopthalmus)