DNA:

3 elements.
1. Phosphate
2. Nitrogenous
3. Sugar

Nitrogenous base: AGCT

Tx for peripheral neuropathy:

Both gabapentin and amitriptyline can be used, amitriptyline preferred when it can be taken at
night and mild sedative (improves quality of sleep).

If patient have acute mitral regurge don't give beta blocker, bcoz tachycardia help to reduce
blood flow from left ventricle to left atrium (it reduces the regurgitant jet)

When hypoxia:
1. Only Pulmonary constrict
2. Other eg brain, heart, kidney, intestine vasodilate

Oligospermia
FSH stimulates sertoli to produce androgen binding protein and inhibin , so if fsh low, both ABP
and inhibin low.

Wernicke
MAO
Memory disturbance, ataxia, ophthalmoplegia

Korsakoff: amnesia, confabulation

Doxorubicin causes cardiotoxicity, arrhythmias and congestive heart failure.

Tacrolimus s/e: hyperkalemia

MELAS : get via maternal line, so wont get from dad, autosomal recessive

LBBB after anterior MI, if blood pressure ok and not in cardiac failure just observe.

Organ transplant hyperacute rejection: HLA-C

Respiratory alkalosis can be caused by theophylline and salicylate overdose

Lung condition Absolute contraindication of pregnancy: primary pulmonary hypertension!

Avoid morphine in CKD patient

Homogentisic oxidase deficiency: AR, alkaptonuria, sx: arthritis,CVD,black urine,blue

discoloration of his ear cartilage.

African tick bite fever: eschar at the bite site(lesion with black center), tx is doxycycline

Female cancer:
1. Lung cancer
2. Breast cancer
3. Colon cancer

Male cancer:
1. Lung cancer
2. Prostate cancer
3. Colon cancer

Takayasu:
- ​Age at disease onset ≤40 years
● Claudication of the extremities
● Decreased pulsation of one or both brachial arteries
● Difference of at least 10 mmHg in systolic blood pressure between the arms
● Bruit over one or both subclavian arteries or the abdominal aorta
● Arteriographic narrowing or occlusion of the entire aorta, its primary branches, or large
arteries in the proximal upper or lower extremities
● Aortic regurgitation seen around in 20% of patient

Constipation in cancer patient(taking morphine): start senna (stimulant laxative)

Pemphigoid vs pemphigus:
1. Mouth lesion common in pemphigus
2. Limbs and trunk in pemphigoid, subepidermal blister, , heal without scarring

Schistosomiasis tx : praziquantel

Hypertrophic olivary degeneration

Group AB is the universal donor for FFP because they produce neither anti-A or anti-B
and is therefore compatible with all ABO groups.
Blood Group A has A antigen on RBC and B antibody in the plasma
Blood Group B has B antigen on RBC and A antibody in the plasma
Blood Group AB has A antigen and B Antigen on RBC and No antibodies in the plasma
Blood Group O has No antigen on RBC and A and B antibody in the plasma
Lead-time bias - occurs when two tests for a disease are compared, the new test
diagnosis the disease earlier, but there is no effect on the outcome of the disease

Tetanus vaccine
If a patient has had 5 doses of tetanus vaccine, with the last dose < 10 years ago, they
don't require a booster vaccine nor immunoglobulins, regardless of how severe the
wound is. Tetanus immunoglobulin is indicated in post-exposure prophylaxis in patients
who are incompletely immunised with a tetanus-prone wound (e.g. open fractures,
heavy contamination, delay to debridement).

Ulcerative colitis: management

Treatment can be divided into inducing and maintaining remission. NICE updated their
guidelines on the management of ulcerative colitis in 2019.

The severity of UC is usually classified as being mild, moderate or severe:

● mild: < 4 stools/day, only a small amount of blood
● moderate: 4-6 stools/day, varying amounts of blood, no systemic upset
 ● severe: >6 bloody stools per day + features of systemic upset (pyrexia,
tachycardia, anaemia, raised inflammatory markers)

Inducing remission

Treating mild-to-moderate ulcerative colitis

● proctitis
○ topical (rectal) aminosalicylate: for distal colitis rectal mesalazine has
been shown to be superior to rectal steroids and oral aminosalicylates
○ if remission is not achieved within 4 weeks, add an oral aminosalicylate
○ if remission still not achieved add topical or oral corticosteroid
● proctosigmoiditis and left-sided ulcerative colitis
○ topical (rectal) aminosalicylate
○ if remission is not achieved within 4 weeks, add a high-dose oral
aminosalicylate OR switch to a high-dose oral aminosalicylate and a
topical corticosteroid
○ if remission still not achieved stop topical treatments and offer an oral
aminosalicylate and an oral corticosteroid
● extensive disease
○ topical (rectal) aminosalicylate and a high-dose oral aminosalicylate:
○ if remission is not achieved within 4 weeks, stop topical treatments and
offer a high-dose oral aminosalicylate and an oral corticosteroid

Rectal ASA—oral ASA—-oral corticosteroid

Severe colitis
● should be treated in hospital
● intravenous steroids are usually given first-line
○ intravenous ciclosporin may be used if steroid are contraindicated
● if after 72 hours there has been no improvement, consider adding intravenous
ciclosporin to intravenous corticosteroids or consider surgery

Maintaining remission

Following a mild-to-moderate ulcerative colitis flare

● proctitis and proctosigmoiditis
○ topical (rectal) aminosalicylate alone (daily or intermittent) or
 ○ an oral aminosalicylate plus a topical (rectal) aminosalicylate (daily or
intermittent) or
○ an oral aminosalicylate by itself: this may not be effective as the other two
options
● left-sided and extensive ulcerative colitis
○ low maintenance dose of an oral aminosalicylate

Following a severe relapse or >=2 exacerbations in the past year

● oral azathioprine or oral mercaptopurine

Other points
● methotrexate is not recommended for the management of UC (in contrast to
Crohn's disease)
● there is some evidence that probiotics may prevent relapse in patients with mild
to moderate disease

Abnormality after giving adrenaline:

Adrenaline induces hyperglycemia, hyperlactatemia and hypokalaemia. Because insulin
secretion is suppressed by alpha adrenergic stimulation, plasma concentration of
insulin remains low. Hyperglycemia is induced by an increase in glucose production
caused by an increase in hepatic glycogenolysis and an increase in gluconeogenesis.
There is also a marked increase in oxygen consumption. In skeletal muscle, epinephrine
increases glycolysis and glycogenolysis, inducing an upsurge in lactate. Muscular
lactate serves as a substrate for hepatic neoglucogenesis (Cori cycle). Epinephrine also
increases lipolysis and decreases muscular proteolysis.
Adrenaline acts like DKA : inhibits insulin secretion by the pancreas, Hyperglycamia
and high lactate. stimulates lipolysis by adipose tissue.

Which painkiller nephrotoxic? Morphine and naproxen nephrotoxic

Poorly controlled hypertension, already taking an ACE inhibitor - add a calcium

channel blocker or a thiazide-like diuretic
If PT<55 yo or having T2DM: first line ACEI
If pt>55 then CCB

The following drugs may exacerbate myasthenia:

● Penicillamine (tx of wilson disease)
● quinidine, procainamide
● beta-blockers
● lithium
● phenytoin
● antibiotics: gentamicin, macrolides, quinolones, tetracyclines

Indications for haemodialysis in salicylate overdose

● serum concentration > 700mg/L
● metabolic acidosis resistant to treatment
● acute renal failure
● pulmonary oedema
● seizures
● Coma
AML: poor prognosis if deletion of chromosome 5 or 7

Double standed circular DNA: mitochondria. circular mitochondriaaa

Urinary incontinence + gait abnormality + dementia = normal pressure hydrocephalus

Alpha antagonists
● alpha-1: doxazosin
● alpha-1a: tamsulosin - acts mainly on urogenital tract
● alpha-2: yohimbine
● non-selective: phenoxybenzamine (previously used in peripheral arterial disease)

Beta antagonists
● beta-1: atenolol
● non-selective: propranolol

Carvedilol and labetalol are mixed alpha and beta antagonists

Charles-Bonnet syndrome (CBS) is characterised by persistent or recurrent complex

hallucinations (usually visual or auditory), occurring in clear consciousness. This is
generally against a background of visual impairment (although visual impairment is not
mandatory for a diagnosis). Insight is usually preserved. This must occur in the absence
of any other significant neuropsychiatric disturbance.
Risk factors include:
● Advanced age
● Peripheral visual impairment
● Social isolation
● Sensory deprivation
● Early cognitive impairment

Remember:
● Gram-positive cocci = staphylococci + streptococci (including enterococci)
● Gram-negative cocci = Neisseria meningitidis + Neisseria gonorrhoeae, also
Moraxella catarrhalis

Therefore, only a small list of Gram-positive rods (bacilli) need to be memorized to

categorize all bacteria - mnemonic = ABCD L
● Actinomyces
● Bacillus anthracis (anthrax)
● Clostridium
● Diphtheria: Corynebacterium diphtheriae
● Listeria monocytogenes

Remaining organisms are Gram-negative rods, e.g.:

● Escherichia coli
● Haemophilus influenzae
● Pseudomonas aeruginosa
● Salmonella sp.
● Shigella sp.
● Campylobacter jejuni

Severe malaria:
- >2%
- Usually due to plasmodium falciparum
- More than 10% consider exchange transfusion

Convert Codeine to morphine: divided by 10, eg6mg x1, QID 24mg codeine, 2.4mg for
morphine.
If switch oral to subcutaneous morphine , divided by two, if switch to parental or subcu
diamorphine, divided by 3
eg. patient taking 60mg BD oral morphine, equal to subcutaneous 60mg/24hours
If switch to transdermal fentanyl then 1:100, times 100, so if 2.4mg fentanyl equal to 240mg oral
morphine
Breakthrough morphine dose:1/6th of daily morphine dose. Eg patient one day takes 30mg, so
breakthrough morphine is 5mg
If current morphine dose can't relieve the pain, increase dose by 30-50% of original dose.

Black crusted lesion(eschar) + fever: tx doxycycline (african tick bite)

Asbestosis:
X ray shows pleural plug, next step?
The correct answer is no follow-up. Pleural plaques are benign and the most common
form of asbestos-related lung disease. They occur after a latent period of 20-40 years.
As they do not undergo malignant change, they do not require follow-up.

Rituximab is the only monoclonal antibody in the R-CHOP regimen and acts against
CD20.

Infliximab targets TNFα and is used in the management of Crohn's disease.

Daratumumab acts against CD38 and is used in the treatment of multiple myeloma.

Alemtuzumab acts against CD52 and can be used to treat chronic lymphocytic
leukaemia.

Trastuzumab (more commonly known as Herceptin) acts against HER2 in metastatic

breast cancer.

Fluconazole inhibits the metabolism of ciclosporin which increases the risk of

ciclosporin nephrotoxicity.

Thrombocytopenia:
QANADAH Not Canada

Quinine, abciximab, NSAIDs, Antibiotics, Diuretics, Anticonvulsants, Heparin

 ALOPECIA causes

● A- anticancer drugs like cycophosphamide, adriamycin

● L- lithium
● O- OCP withdrawal
● P- PTU
● E- ethiomide,
● C- colchicine, carbimazole
● I- interferons
● A- anticoagulant like heparin, Vit A excess

Statins + erythromycin/clarithromycin - an important and common interaction. Can

cause rhabdomyolysis.

When there is a mix of UMN and LMN signs in a patient, always consider SCDC.

Hypertension in pregnancy in usually defined as:

● systolic > 140 mmHg or diastolic > 90 mmHg

● or an increase above booking readings of > 30 mmHg systolic or > 15 mmHg
diastolic

Tularaemia: zoonotic infection, transmitted through rabbit, hares, pikas. Present as

erythematous papulo-ulcerative lesion at the site of the bite with reactive and ulcerating
regional lymphadenopathy. It is treated with antibiotics such as doxycycline.

What is golimumab? It is treatment of Ankylosing Spondylitis, its TNF inhibitor. First line
treatment of AS, NSAIDS and exercise. ANTI-TNF given if persistently high disease
activity. Eg adalimumab and etanercept
Cat scratch disease. Most cases of cat scratch disease (CSD) resolve without
treatment, although some patients may develop complications from disseminated
disease. Azithromycin has been shown to decrease lymph node volume more rapidly
compared to no treatment.

Thrombectomy window period?

6hours
Remember thrombolysis 4 hours, thrombectomy 6 hours

DDD's of Docetaxel: It prevents microtubule Depolymerisation & Disassembly, thereby

Decreasing free tubulin.

Which one of the following markers is most useful for monitoring the progression of patients with
chronic obstructive pulmonary disease?
FEV1

Inducers of the P450 system include

● antiepileptics: phenytoin, carbamazepine

● barbiturates: phenobarbitone
● rifampicin
● St John's Wort
● chronic alcohol intake
● griseofulvin
● smoking (affects CYP1A2, reason why smokers require more aminophylline)

Inhibitors of the P450 system include

● antibiotics: ciprofloxacin, erythromycin

● isoniazid
● cimetidine,omeprazole
● amiodarone
● allopurinol
● imidazoles: ketoconazole, fluconazole
● SSRIs: fluoxetine, sertraline
● ritonavir
 ● sodium valproate
● acute alcohol intake
● quinupristin

Pellagra has (3) Ds, (N)iacin is Vitamin B(3), also known as (N)icotinic acid
Niacin (B3) deficiency is characterised by dermatitis, diarrhoea and dementia, a condition
known as pellagra

Morphine toxicity: respi depression, reduced conscious evel, myoclonic jerk, pinpoint
pupil.

Cause of low magnesium

● drugs
○ diuretics
○ proton pump inhibitors
● total parenteral nutrition
● diarrhea
○ may occur with acute or chronic diarrhoea
● alcohol
● hypokalaemia
● hypercalcaemia
○ e.g. secondary to hyperparathyroidism
○ calcium and magnesium functionally compete for transport in the thick
ascending limb of the loop of Henle
● metabolic disorders
○ Gitleman's and Bartter's

SIADH drug causes: carbamazepine, sulfonylurea, SSRIs, TCA

Test for pancreatic function:

Secretin stimulation test

TRALI VS TACO
TACO presents with hypertension due to volume excess, whereas TRALI presents
with hypotension due to ARDS and the resultant hypovolaemic shock.TRALI is
 likely to be associated with fever and leukopenia, whereas TACO usually has
neither.

Treatment of neiserria gonorrhoea?

- Single dose of IM ceftriaxone
If chlamydia then 7 days of oral doxycyclin

DKA management, see the blood pressure cue

If SBP>90, run 1L NS 0.9% over 1 hour
If SBP<90, run 500ml NS 0.9% over 5 mins

Patients with von Hippel-Lindau syndrome may develop retinal haemangiomas which
present as a vitreous haemorrhage. Patients develop multiple cysts and tumours
affecting a large number of body systems. Subarachnoid haemorrhage is common
secondary to cerebral haemangiomas and vitreous haemorrhage is a common
presentation for retinal haemangiomas. Patients are also at increased risk of
phaeochromocytoma, clear-cell renal cancer and cysts involving the pancreas, liver and
epididymis.

Defective collagen
Type 1: osteogenesis imperfecta
Type 2: chondrodysplasia
Type 3: Ehler(3hler) Danlos syndrome (E 3 horizontal lines so type 3 lor)
Type 4: Good4asture syndrome
Type 5: less common variant of ehler danlos syndrome (Variant=V)

Oseltamivir: neurominidase inhibitor

Pulmonary embolism:
T wave inversion in the right precordial leads (V1-V4) is associated with raised
pulmonary pressures, of which a PE is a known cause.
PE due to thrombophilia. Of all the inherited causes of thrombophilia, Factor V Leiden is
the most common and is present in 3-5% of the population. Factor V Laiden mutation
results in activated protein C resistance.

Lichen planus tx:

1st line is topical steroid eg clobetasol
Description of lichen: papular, polygonal, violaceous, flat-topped rash is present on the
palms, in her elbow creases and on the soles of her feet.

DRESS(drug reaction with eosinophilia and systemic symptoms) syndrome presents

with a triad of extensive skin rash, high fever, and organ involvement.
SJS and TEN limited to skin only, wont cause other organ involvement. SJS usually
mucosal involvement, TEN causes desquamating skin lesion

Seizure and driving

First unprovoked seizure:
If drive car: stop 6 month
If drive lorry: stop 5 years
If establish seizure:
Free seizure for 12 months then ok to drive
Free seizure(with med) for 5 years then ok to drive

Syncope
● simple faint: no restriction
● single episode, explained and treated: 4 weeks off
● single episode, unexplained: 6 months off
● two or more episodes: 12 months off

stroke or TIA: 1 month off driving, may not need to inform DVLA if no residual
neurological deficit

CHEMO DRUG ACTION!!!!!!!!!!

Cyclophosphamide: crosslink DNA
Hydroxyurea: inhibition of ribonucleotide reductase (hydro,ribo, got rhyme mou)
Vincristine: prevent formation of microtubule
Fluorouracil: pyrimidine analogue

Regular cannon waves and irregular cannon waves (JVP)

Cannon waves are caused by simultaneous contraction of atria and ventricle leading to
exaggerated right atrial pressure.
Regular: Atrio-ventricular nodal re-entry tachycardia(AVNRT) and ventricular tachycardia with
1:1 ventricular-atrial conduction
Irregular: Complete heart block

Acne drug that's safe in pregnancy?

-erythromycin

Prosthetic heart valves - antithrombotic therapy:

● bioprosthetic: low dose aspirin long term, warfarin first 3 months
 ● mechanical: warfarin + aspirin(for IHD pt)

Target INR:
Aortic: 3.0
Mitral: 3.5

Turner syndrome increased incidence of autoimmune disease (especially autoimmune

thyroiditis) and Crohn's disease

Homonymous hemianopia
Incongruous defect: more anterior eg optic tract lesion
Congruous defect: more posterior optic radiation lesion or occipital cortex
homonymous quadrantanopias: PITS (Parietal-Inferior, Temporal-Superior)

Which cells secretes majority of TNF? Macrophage

PPV = TP / (TP + FP)

Complete heart block auscultation: variable intensity S2

Women with hypothyroidism may need to increase their thyroid hormone replacement
dose by up to 50% as early as 4-6 weeks of pregnancy

Young Patient presented with

1. Abdominal pain
2. Ascites
3. hepatomegaly
Think of BUDD CHIARI SYNDROME.
Risk factor: pregnancy, postpartum, OCP
Investigation: abdominal US with doppler

Chikungunya:
1. Severe joint pain (generalised)
2. Fever
3. Absence of rash
4. Normal blood test
5. Africa

Skin disorder Associated malignancies

Acanthosis nigricans Gastric cancer

Acquired ichthyosis Lymphoma

Acquired hypertrichosis Gastrointestinal and lung cancer

lanuginosa

Dermatomyositis Ovarian and lung cancer

Erythema gyratum repens Lung cancer

-wood-grain appearance

Erythroderma Lymphoma

Migratory thrombophlebitis Pancreatic cancer

Necrolytic migratory erythema Glucagonoma

Pyoderma gangrenosum Myeloproliferative disorders
(bullous and non-bullous
forms)

Sweet's syndrome Haematological malignancy e.g.

Myelodysplasia - tender, purple plaques

Tylosis Oesophageal cancer

Hashimoto's thyroiditis is associated with thyroid lymphoma

Angiomyolipoma = Tuberous sclerosis

Angiomatosis = Von Hippel Lindau syndrome

Multiple sclerosis pt presents with urinary frequency

NICE guidelines for 'urinary incontinence in neurological disease' recommend the use of
bladder ultrasound during initial clinical assessment.

Transmission of which type of infection is most likely to occur following a platelet

transfusion?
Bacterial!!!

Gingival hyperplasia: PANiC

1. phenytoin,
2. AML
3. Nefedipine (CCB)
4. ciclosporin,

Dermatitis herpetiformis
- caused by IgA deposition in the dermis
- ass with celiac disease
Drug induced lupus:
Common cause: procainamide, hydralazine
Common feature: skin rash, pleurisy
Less common feature: glomerulonephritis
Aortic dissection
Type A: ascending aorta, tx: IV labetalol + surgery
Type B: descending aorta, control BP enough. (coz not severe enough to cause further heart
strain so oklah no need surgery)

Eosinophilic oesophagitis
Tx: dietary modification +/- topical steroid. The six-food elimination diet (SFED) is the
most frequently employed dietary therapy in patients with EoE. This diet typically trials
the exclusion of wheat, milk, egg, nuts, soy, fish and shellfish. An upper endoscopy and
biopsy is performed after six weeks of the SFED diet.

X ray: bell shaped cavity with crescent sign. What diagnosis?

Ans: aspergilloma

If C. difficile does not respond to first-line vancomycin , oral fidaxomicin should be used
next, except in life-threatening infections

Causes of primary hyperparathyroidism

● 80%: solitary adenoma
● 15%: hyperplasia
● 4%: multiple adenoma
● 1%: carcinoma

Tetracycline side effects:

 - Photosensitive rash
- SJS
- Exfoliative dermatitis
- grey discolouration of the teeth in neonates if they are given to pregnant women
in the second or third trimester

Retinoin side effect: dry lips and tongue

H1n1 influenza treatment: tamiflu and ralenza

Ralenza side effect: bronchospasm (be aware in asthmatic patient)

Raynaud phenomenon:
Can be divided into primary causes and secondary causes
How to differentiate: primary usually onset in young women(<40yo) and bilateral
symptoms.

​HLA antigens are encoded for by genes on chromosome 6

Fungal nail infection (onychomycosis)
-mainly by trichophyton rubrum
-tx first line: oral terbinafine, alternative itraconazole
-6 weeks - 3 months therapy is needed for fingernail infections whilst toenails should be
treated for 3 - 6 months

RULESSS for driving with medical condition

Group 1 is car, group 2 is lorry
Specific rules
● hypertension
○ can drive unless treatment causes unacceptable side effects, no need to
notify DVLA
○ if Group 2 Entitlement the disqualifies from driving if resting BP
consistently 180 mmHg systolic or more and/or 100 mm Hg diastolic or
more
● angioplasty (elective) - 1 week off driving
● CABG - 4 weeks off driving
● acute coronary syndrome- 4 weeks off driving
○ 1 week if successfully treated by angioplasty
● angina - driving must cease if symptoms occur at rest/at the wheel
● pacemaker insertion - 1 week off driving
● implantable cardioverter-defibrillator (ICD)
○ if implanted for sustained ventricular arrhythmia: cease driving for 6
months
 ○ if implanted prophylactically then cease driving for 1 month. Having an
ICD results in a permanent bar for Group 2 drivers
● successful catheter ablation for an arrhythmia- 2 days off driving
● aortic aneurysm of 6cm or more - notify DVLA. Licensing will be permitted
subject to annual review.
○ an aortic diameter of 6.5 cm or more disqualifies patients from driving
● heart transplant: do not drive for 6 weeks, no need to notify DVLA

Statin contraindication:
● macrolides (e.g. erythromycin, clarithromycin) are an important interaction. Statins
should be stopped until patients complete the course
● pregnancy

Aortic stenosis management:

1. If patient asymptomatic do ntg
2. When to do aortic valve replacement,
a. When the gradient is >40
b. When patient becomes symptomatic, evidence of significant left
ventricular dysfunction

Diarrhea + rash, after returning from south east asia

- Strongyloides stercoralis

SACK ALL THE FARMERS: saccaropolyspora, farmers

Mechanism of action of ciclosporin:

Mneumonic: CiclosporIN CalcineurIN, so it inhibit calcineurin

According to nice guideline, first line of OA is:

Paracetamol +- topical NSAIDs (hmm different with malaysia guideline lol)

Disseminated gonococcal infection triad = tenosynovitis, migratory polyarthritis,

dermatitis

There is consensus that all patients should receive oral prednisolone within 72 hours of
onset of Bell's palsy. Eye care is important - prescription of artificial tears and eye
lubricants should be considered

ADPKD type 1 = 16 to the power of 1 , first number = chromsome 16

ADPKD type 2 = 4 to the power of 2 , also 16 but first number = chromsome 4
NF1: chromosome 17 - as neurofibromatosis has 17 characters
NF2: chromosome 22 - all the 2's

Antihypertensive: this is WTF question

For patients of black African or African–Caribbean origin taking a calcium channel blocker for
hypertension, if they require a second agent consider an angiotensin receptor blocker(ARB) in
preference to an ACE inhibitor

If C. difficile does not respond to first-line vancomycin , oral fidaxomicin should be used next,
except in life-threatening infections

Bactericidal vs bacteriostatic antibiotics, how to memorise damnnn, ok memorise bacteriostatic

enough, mnemonic core medical trainee to specialist trainee
C chloramphenicol
M macrolides
T tetracyclines
S sulphonamides
T trimethoprim

Hereditary angioedema - C4 is the best screening test in between attacks. Autosomal dominant.
If during attack and test, c1-inh is low.

Leprosy: can present as hypopigmented and sensory loss. Recommended therapy: rifampicin,
dapsone and clofazimine

Catamenial pneumothorax is the cause of 3-6% of spontaneous pneumothoraces occurring in

menstruating women. It is thought to be caused by endometriosis within the thorax
Antibiotic

Brilliant way to remember what’s associated with acanthosis nigraicans:

Acanthosis nigricans are associated with all the things that are associated with weight
gain: hypothyroid, DM, acromegaly, prader willi, PCOS, COCP, obesity. And then just gotta
remember gastric ca on top

QRISK2 should not be used in the following situations as there are more specific guidelines for
these patient groups:
● type 1 diabetics
● patients with an estimated glomerular filtration rate (eGFR) less than 60 ml/min and/or
albuminuria
● patients with a history of familial hyperlipidaemia

​
Standard error of the mean = standard deviation / square root (number of patients)

Lichen
● planus: purple, pruritic, papular, polygonal rash on flexor surfaces. Wickham's striae over
surface. Oral involvement common
● sclerosus: itchy white spots typically seen on the vulva of elderly women
11;14 -> 11 looks like a M -> Mantle
8;14 -> 8 looks like B -> Burkitt
9;22 -> 9 looks like flipped P -> Philadelphia
15,17 -> well it's none of the above :D -> it's the long name Acute Promyelocytic
Leukemia.
14:18 : Difference = Four = FOURllicular Lymphoma

Zero-order kinetics refers to the rate of excretion being constant, regardless of changes in
plasma concentration of the drug. Drugs which exhibit zero-order kinetics include phenytoin,
alcohol and salicylates(apsirin)

Acne treatment
(step up tx)
Single topical (topical retinoids, benzoyl peroxide) --> Combination topical (topical antibiotic,
benzoyl peroxide, topical retinoid) --> oral Abx (tetracycline)--> oral isotretinoin

Gaucher's disease is an autosomal recessive disease and it is the most common lipid
storage disorder. It's a cause of hepatosplenomegaly. Can present as aseptic necrosis
of femur

Liver failure following cardiac arrest, think about ischemic hepatitis, another clue is
aminotransferase level will >1000
a low concentration of BNP(< 100pg/ml) makes a diagnosis of heart failure unlikely, but
raised levels should prompt further investigation to confirm the diagnosis

Syphilis:
false positive non-treponemal (cardiolipin) tests(VDRL test):
SomeTimes Mistakes Happen
SLE
TB
Malaris
HIV

Extrinsic allergic alveolitis (same as hypersensitivity pneumonitis) is a type III and IV reaction,
no eosinophils involved

Rosacea treatment:
● mild/moderate: topical metronidazole
● severe/resistant: oral tetracycline

NICE guidelines suggest first-line treatment for diabetic neuropathy is the same as for
other causes of neuropathic pain with amitriptyline, duloxetine, gabapentin or
pregabalin.
Pityriasis versicolor: first line tx ketoconazole shampoo

Pneumonia + Alcoholic + Cavitation = Klebsiella

Pneumonia + Prior Flu/cold sores(blister) = Staph Pneumonia
Pneumonia + after influenza= S. aureus
Pneumonia + Chicken Pox Rash = Varicella
Pneumoniae Pneumonia + Hemolytic Anemia = Mycoplasma
Pneumonia + Hyponatraemia + Travel History = Legionella
Pneumonia + Fleeting opacities = Cryptogenic Pneumonia
Pneumonia + Fits/LOC = Aspiration Pneumonia
Pneumonia + HSV oral lesion = Strep Pneumonia
Pneumonia + parrot = Chlamydia psitatssi
Pneumonia + farm animals = Q fever (coxillea brunetii)
Pneumonia + HIV = think pcp but if straight forward case strep pneumonia is still most common
Pneumonia + Cystic fibrosis = consider pseudomonas/Burkholderia
Pneumonia + COPD or exac = c1::Haemophilus Influenza
Commonest cause of CAP = Strep Pneumonia

Before testing urea breath test:

 ● No antibiotic for 4 weeks
● No PPI for 2 weeks

Oculogyric crisis:
Causes
● antipsychotics
● metoclopramide
● postencephalitic Parkinson's disease

ABCDE mnemonic for QT prolongation

anti Arrhythmic
anti Biotic
antipsy Chotic
anti Depressants
anti Emetics
+ Electrolyte eg hypocalcemia, hypokalemia, hypomagnesiumia

Varicella pneumonia is the most common and serious complication of chickenpox

infection in adults. Auscultation of the chest is often unremarkable. Give IV acyclovir in
this condition.

Nystagmus
Upbeat nystagmus
● cerebellar vermis lesions
Downbeat nystagmus - foramen magnum lesions
● Arnold-Chiari malformation
Vermis- top of cerebellum- upbeat nystagmus
Arnold-Chiari- cerebellar tonsils are low- Downbeat nystagmus

G6pd avoid quinolone eg ciprofloxacinnnn

B' symptoms in Hodgkin's lymphoma are associated with a poor prognosis

● weight loss > 10% in last 6 months
● fever > 38ºC
● night sweats

When to stop exercise tolerance test(stress test)?

ST depression 3mm, ST elevation 2mm, SBP>230, heart rate fall 20%, SBP fall 20%

Ulcer:
Lymphogranuloma venereum - Chlamydia trachomatis

Unvaccinated pregnant lady come into contact with chicken pox child. No vaccinated b4.MX?
- Get varicella immunoglobulin (for ≤20 weeks lady)
- If normal ppl just inject vaccine can
- If kena chicken pox aldy how? Give acyclovir if ≥20weeks, <20 weeks use in
caution(refer)

Situation: old man falls frequently, taking anticoagulants regularly. What should u do?
- Continue anticoagulant, risk of fall or old age is not a reason to withhold anticoagulant
(NOAC)

Human bites, like animal bites, should be treated with co-amoxiclav.

Erythema nodosum causes mneumonic:

NODOSUM
NO: NO causes in 80% of cases
D : Drugs (sulfonamides; amoxicillin)
O : Oral contraceptive pills
S : Sarcoidosis/ Tuberculosis
U : Ulcerative colitis; Crohn's disease; Behcet disease
M: Micro
Viral : HSV; EBV; Hep B; Hep C
Bacterial: campylobacter; salmonella; streptococci; Brucellosis
Parasite : Amoebiasis; Giardiasis

Metabolic ketoacidosis with normal or low glucose: think alcohol excess

What can cause impaired glucose tolerance?

Mneumonic TASTINg
Thiazide
Antipsychotic
Steroid
T cell (tacrolimus/cyclosporin)
IFN-alpha
Nicotinic acid

Paracetamol overdose case: when to give paracetamol?

- After 24 hours, ph<7.3 or
- Prothrombin time > 100 seconds AND
- Creatinine > 300 µmol/l AND
- Grade III or IV encephalopathy
P. knowlesi has the shortest erythrocytic replication cycle, leading to high parasite
counts in short periods of time

For motor neurone disease, whats the tx?

NIV is better than riluzole

average plasma glucose = (2 * HbA1c) - 4.5

Interferon-alpha -> Hep B treatment

Interferon-beta -> Multiple sclerosis treatment
Interferon-gamma -> TB test

If question ask about a black lady, everything ok except neutrophils low, why??
- Bcoz Benign ethnic neutropaenia is common in people of black African and
Afro-Caribbean ethnicity lol

Paget disease (bone)

-increase level of urinary hydroxyproline

Prediabetes patient, try hard for lifestyle still prediabetes range. Mx?
- Start metformin. NICE recommend metformin for adults at high risk 'whose blood
glucose measure (fasting plasma glucose or HbA1c) shows they are still
progressing towards type 2 diabetes, despite their participation in an intensive
lifestyle-change programme

Fabry disease typically presents with proteinuria and is associated with early onset
strokes or myocardial infarctions with a typical rash known as angiokeratomas.

Anthrax
-The skin form presents with a small blister with surrounding swelling that often turns into a painless
ulcer with a black center
Treated with ciprofloxacin
The finding of black eschar with regional lymphadenopathy in a patient that works with
livestock is a typical history for cutaneous anthrax

Migraine treatment
● acute: triptan + NSAID or triptan + paracetamol
● prophylaxis: topiramate or propranolol
Pseudogout can be caused by hemochromatosis!!!! How to differentiate with gout? It has
chondrocalcinosis.

Skin
Craters, volcanos indicate keratoacanthoma. Basal cell will be flatter with raised edges,
telangiectasias, pearly white and slow growing.

Melanoma: the invasion depth of the tumour is the single most important prognostic factor

Marfan's syndrome and homocystinuria can be difficult to differentiate clinically.

However, Marfan's syndrome is typically associated with upwards lens dislocation,
unlike the downwards dislocation of the lens in homocystinuria. The heart is rarely
affected in homocystinuria, whereas aortic regurgitation is common in Marfan's. The
recurrent thrombosis noted in this case is also more typical of homocystinuria. Marfan's
syndrome is inherited in an autosomal dominant fashion where homocystinuria is
inherited in an autosomal recessive fashion.

This is a case of variant Creutzfeldt-Jakob disease (vCJD). The typical presentation is that of a
younger patient with progressive dementia (less rapid the sporadic CJD) with myoclonus and, in
the later stages, mutism and vertical upgaze palsy (found in 50%). An MRI brain reveals a
characteristic 'hockey stick sign' where the pulvinar region and dorsomedial thalamus are
hyperintense on T2-weighted imaging (or pulvinar sign where the pulvinar region is
hyperintense only). CSF protein for 14-3-3 and periodic sharp wave complexes on the EEG are
more commonly seen in sporadic CJD.

PSP present with downwards gaze.

larva migrans: there are two disease entities: cutaneous (caused by Ancylostoma) and visceral
(cause by toxocara).
- cutaneous larva migrans: IVERMECTIN or THIABENDAZOLE.
- visceral larva migrants: self limited. steroids if severe. ALEBENDAZOLE for eradication

Campylobacter infection is often self-limiting but if severe then treatment with clarithromycin
may be indicated

Acute pancreatitis causes:

Not hypercholesterol, is hypertriglyceridemia

Seborrhoeic dermatitis - first-line treatment is topical ketoconazole

Which one of the following rises first following a myocardial infarction?

-myoglobin

primary open-angle glaucoma

The common 1st line treatment of primary open-angle glaucoma includes β-blockers,
prostaglandin analogues, carbonic anhydrase inhibitors and alpha-2-agonists. We are
told in the stem that the patient is unable to tolerate brinzolamide (carbonic anhydrase
inhibitors), latanoprost (prostaglandin analogues) and brimonidine (alpha-2-agonist).
This leaves beta-blockers like timolol as the remaining choice. This acts by reducing the
aqueous humour production of the eye.

Carbonic anhydrase inhibitors (acetazolamide/dorzolamide/brinzolamide) also act by

reducing aqueous humour production. So conclusion, beta blocker and carbonic
anhydrase reduce aqueous humour production.

Prostaglandin analogues (latanoprost) acts by increasing the uveoscleral outflow.

Alpha-2-agonists ( brimonidine) improves symptoms by having a dual action (reducing

humour production and increased outflow).

Mydriatic drops are a known precipitant of acute angle closure glaucoma. This scenario
is more common in exams than clinical practice.
Pharyngitis + Bradycardia = Diphtheria

Paget's disease - increased serum and urine levels of hydroxyproline. Paget’s disease, a
condition where uncontrollable bone turnover occurs, most likely due to a disorder of
the osteoclast. Paget’s disease commonly affects males in older age who typically
present with bone pain and other systemic complications. Bone remodelling of the skull
can result in compression of the auditory nerve resulting in hearing issues, headaches,
tinnitus and vertigo. Bossing of the skull, often noticed as an increase in hat size, can
occur in untreated Paget’s disease as well as bowing of the tibias. Alkaline phosphatase
is normally raised in Paget’s disease but blood tests such as calcium, phosphate,
vitamin D and parathyroid hormone are usually unaffected.
Classic radiological findings of Paget's includes bone expansion with a coarsened
trabecular pattern. Other markers of bone turnover including hydroxyproline, which is
raised in both the urine and serum, as well as procollagen type I N-terminal propeptide
(PINP), C-telopeptide (CTx) and N-telopeptide (NTx).

Asthma:
Adults with suspected asthma should have both a FeNO test and spirometry with
reversibility

Idiopathic intracranial hypertension (also known as pseudotumour cerebri and formerly

benign intracranial hypertension) is a condition classically seen in young, overweight
females.

Risk factors
● obesity
● female sex
● pregnancy
● drugs*
○ combined oral contraceptive pill
○ steroids
○ tetracyclines
○ vitamin A
○ lithium

Carcinoid syndrome is a neuroendocrine tumour. There are many locations that they can
occur in such as in the GI tract, in the respiratory tract and many other places. They can
secrete serotonin which leads to many of the symptoms this patient suffers. The
syndrome is associated with right-sided valvular pathology. The most common
pathology is tricuspid insufficiency and pulmonary stenosis
Torches infection during pregnancy:
Congenital toxoplasmosis is the classic triad of cerebral calcification, chorioretinitis and
hydrocephalus.
Congenital syphilis can cause sensorineural hearing loss, it is typically associated with
frontal bossing interstitial keratitis and Hutchinson's teeth.
Congenital rubella is incorrect. This typically presents at birth and is characterized by
cataracts, cardiovascular defects and a 'blueberry muffin' rash i.e. petechiae and
purpura
Congenital CMV is incorrect. This can cause SNHL and chorioretinitis. However, this is
typically characterized by microcephaly rather than hydrocephalus. Furthermore,
calcification tends to be periventricular rather than scattered. Additionally, 'blueberry
muffin' skin tends to be a feature of CMV but not congenital toxoplasmosis.

Nivolumab (PD-1 inhibitor) and ipilimumab (CTLA-4 inhibitor) are checkpoint inhibitors
which are used in the treatment of metastatic melanoma. Effects on the endocrine
system are being increasingly reported with prolonged therapy (hypophysitis and
hypothyroidism) and therefore it is important to assess patients carefully who present
with symptoms of hypothyroidism whilst on these drugs

​n-MYC is an oncogene for neuroblastoma

ABL is an oncogene found in chronic myeloid leukaemia. c-MYC is an oncogene found
in Burkitt's lymphoma. Ras is an oncogene found in many cancers, but mostly
pancreatic cancer.

​Cardiac involvement is the leading cause of death in patients with Chagas' disease

Cetuximab - monoclonal antibody against the epidermal growth factor receptor

Blood pressure measurement is important in ciclosporin therapy. Urinalysis is required

for gold and penicillamine (for protein due to the risk of membranous
glomerulonephritis) and cyclophosphamide (for blood due to the risk of haemorrhagic
cystitis and bladder cancer).

Second heart sound (S2)

● loud: hypertension
● soft: AS
● fixed split: ASD
● reversed split: LBBB
UC patient:
Patients who are allergic to aspirin may also react to sulfasalazine.

Bupropion should not be used in a patient with epilepsy as it reduces seizure threshold

Amiodarone induced thyrotoxicosis

AIT type 1 AIT type 2

Pathophysiology Excess iodine-induced thyroid Amiodarone-related destructive

hormone synthesis thyroiditis

Goitre Present Absent

Management Carbimazole or potassium Corticosteroids

perchlorate

Urinary histamine is used to diagnose systemic mastocytosis

Systemic mastocytosis is associated with increased histamine production that
subsequently increases gastric acid secretion. This predisposes patients with systemic
mastocytosis to gastritis and peptic ulcers, which is consistent with the presentation
above. Systemic mastocytosis is also associated with urticaria pigmentosa. This is a
rash characterised by innumerable reddish-brown papules that undergo an urticarial
reaction on irritation. This urticarial reaction is known as Darier's sign. Urticaria
pigmentosa typically occurs in childhood forms of the disease, but it can also occur in
adults and tends to persist for longer. Raised serum tryptase and urinary histamine
levels are seen in systemic mastocytosis.

Carbonic anhydrase inhibitors include dorzolamide and acetazolamide

Retinitis pigmentosa - night blindness + tunnel vision

Causes of drug-induced photosensitivity

● thiazides
● tetracyclines, sulphonamides, ciprofloxacin
● amiodarone
● NSAIDs e.g. piroxicam
● psoralens
 ● sulphonylureas

An acute history of abdominal pain in those who have ingested cocaine should alert
one towards the possibility of ischaemic colitis. Cocaine is a profound vasoconstrictor
and can reduce blood supply to the gut. This can sometimes be accompanied by rectal
bleeding.

The presentation of malnutrition (anaemia, low albumin, B12 deficiency), diarrhoea

and weight loss in a patient with a background of Crohn's disease and scleroderma is
highly suggestive of small bowel overgrowth syndrome (SBOS). Folate levels are
raised due to increased production by the bacteria. The first-line test is a hydrogen
breath test. There are excessive bacteria in the small intestine, associated with the
myopathic process in scleroderma and inflammatory bowel disease.

The hyponatraemia and potassium towards the upper end of the normal range, coupled
with hypoglycaemia, fit well with a diagnosis of Addison's disease. Although features
of hypothyroidism may co-exist with hypoadrenalism, corticosteroid replacement is
the most important first step in therapy because commencing thyroxine may worsen
any adrenal crisis.

If you suspect established or developing adrenal crisis in a patient

Please immediately inject 100mg hydrocortisone i.v. or i.m. followed by rapid
rehydration with i.v. administration of 0.9% saline solution (or equivalent).

Although electroconvulsive therapy, by definition, causes a controlled seizure there is

no increased risk of epilepsy in the long-term.

Pompholyx is a type of eczema which affects both the hands (cheiropompholyx) and the feet
(pedopompholyx). It is also known as dyshidrotic eczema.

Pompholyx eczema may be precipitated by humidity (e.g. sweating) and high temperatures.

Features
● small blisters on the palms and soles
● pruritic
○ often intensely itchy
○ sometimes burning sensation
● once blisters burst skin may become dry and crack
Which one of the following foods is the best source of folic acid?
-liver

Which one of the following drugs is most likely to precipitate lithium toxicity
Lithium toxicity can be precipitated by thiazides
Toxicity may be precipitated by:
● dehydration
● renal failure
● drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor
blockers, NSAIDs and metronidazole.

Benzydamine hydrochloride mouthwash or spray may be useful in reducing the discomfort

associated with a painful mouth that may occur at the end of life