LAST MINUTE MRCP CRAMMING FACTS: please add your own too

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  1. Guest

    Guest Guest

    This is a list of commonly tested facts, if you have corrections or you have some of your own, please add them

    TOP 50 MRCP facts

    1. Acromegaly – Diagnosis: OGTT followed by GH conc.
    2. Cushings – Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen
    3. Rash on buttocks – Dermatitis herpetiformis (coeliac dx)
    4. AF with TIA --> Warfarin
    5. Herpes encephalitis --> temporal lobe calicification
    6. Obese woman, papilloedema/headache --> Benign Intercanial Hypertention
    7. Drug induced pneumonitis --> methotrexate or amiodarone
    8. chest discomfort and dysphagia --> achalasia
    9. foreign travel, macpap rash/flu like illnes --> HIV acute
    10. cause of gout --> dec urinary excretion
    11. bullae on hands and fragule skin torn by minor trauma --> porphyria cutanea tarda
    12. Splenectomy --> need pneumococcal vaccine 2 weeks pre-op and for life
    13. primary hrperparathyroidism --> high Ca, normal/low PO4, normal/high PTH (in elderly)
    14. middle aged man with KNEE arthritis --> gonococcal sepsis (older people -> Staph)
    15. sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome benign, no Rx needed
    16. tremor postural,slow progression,titubation, relieved by OH->benign essential tremor AutD
    17. electrolytes disturbance causing confusion – low/high Na
    18. contraindications lung surgery --> FEV <1.5, MALIGNANT effusion, mets outside lung
    19. prevent further renal deterioration/proteinuria--> dec bp 130/90, Ace inhibitors
    20. headache with many analgesics at once -> analgesic induced headache
    21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance angiogram
    22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion
    23. severe retroorbital, daily headache, lacrimation --> cluster headache
    24. pemigus – involves mouth (mucus membranes), pemphigoid – less serious NOT mucosa
    25. diagnosis of polyuria -> water deprivation test, then DDAVP
    26. insulinoma -> 24 hr supervised fasting hypoglycaemia
    27. Diabetes Random >7 or if >6 OGTT -> >11.1 also seen in HCT
    28. causes of villousd atrophy: coeliac, Whipples, dec Ig, lymphoma, trop sprue (rx tetracycline)
    29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets
    30. hepatitis B with general deterioration -> hepaocellular carcinoma
    31. albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis)
    32. HBSag positive, HB DNA not detectable --> chornic carier
    33. Inf MI, artery invlived -> Right coronary artert
    34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, familial hyperchol,Gilbert, Huntington's, Marfans's, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers
    35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B
    36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR
    37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2
    38. 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
    39. MVP sudden worsening post MI. Harsh systolic murmur radites to axilla.
    40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia
    41 Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy, radiotherapy, toxins
    42. Tumor compressing Respiratory tract --> investigation: flow volume loop
    43. 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. TRIES TO YANK THE ipsilateral BAD EYE ACROSS THE NOSE. Convergence is normal. Causes: MS, SLE, Miller fisher, overdose(barb, phenytoin, TCA), Wernicke
    46.Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal dolls eye. i.e. Occulomotor nuclei intact, supranuclear pathology
    47 Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS.
    48. demetia, gait abnormaily, urinary incontinence. Absent papilloedema-->Normal pressure hydrocephalus.
    49. acute red eye -> acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcleritis, subconjuntival haemmorrhage)
    50. wheeles, urticaria, drug induced -> aspirin
    51. sweats and weight gain -> insulinoma
    52. diagnostic test for asthma -> morning dip in PEFR >20%
    53. causes of SIADH: Lithium, chlorpropamide, carbamepine
    54. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vit Dalso)
    55. returned from airline flight, TIA-> paradoxical embolus do TOE
    55. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff
    56. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute

    High Yield Topics
    1. Anorexia Nervosa
    2. Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Yersinia, Salmonella, Shigella. Balanisits.
    3. PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
    4. Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis
    5. Heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
    6. Vitiligo – commonest assoctions pernicious anaemia >>> type 1 dm, autoimmune addisons, autoimmune thyoid dx

    ALMOST Pathognomic for the exam
    1.fatiguability -> myasthrnia gravis
    2.fasciculations -> Motor neurone diease
    3.silvery white scale -> psoriasis
    4.hypopigmented -> vitiligo/pityriasis versicolor

    please ONLY ADD COMMONLY TESTED FACTS THAT YOU HAVE SEEN REPEATEDLY IN PAST EXAM QUESTIONS
  2. re. error

    Correction to line 53 SORRY!

    53. Causes of SIADH : chest/cerebral/pancreas pathology, porphyria
    Drugs: carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs

    Causes of Diabetes Insipidus: Lithium, amphoteracin, prologed hypercalcaemia/hypornatraemia, familial X linked type, pituitary damage
  3. Guest

    Guest Guest

    47 Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS.

    ---> Convergence should be defective. Isn't it?
  4. Guest

    Guest Guest

    re 47 parinauds

    from Kalra pg. 563
    ------------------------------------------------------------------
    Parinauds syndrome :-

    impaired upgaze and accomodation
    retraction of the eyelids
    loss of light reflex with preserved convergence reflex
    convergent retraction nystagmus
    relative midriasis
    ------------------------------------------------------------------

    ?presumably convergant retraction nystagmus means when eyes are returning to neutral from convergence when it happens...?
  5. Guest

    Guest Guest

    re. list reposted

    see the main forum, i reposted the list. made correction to nummber 53 (now number 43).
  6. Guest

    Guest Guest

    query

    kindly let me know what all books should one study for MRCP part 2 preparation, i would highly greatful
  7. Guest

    Guest Guest

    can anyone guide regarding the online courses for mrcp part 2 is onexamination good
  8. passed MRCP part 1, now comments and suggestions

    Thank the Lord!

    Passed MRCP Part 1 on first attempt. Mark not yet available.

    To all those who did not pass - I think this has nothing to do with ability as a doctor - do not feel bad, just try again, study differently. It is really a very silly exam but a hurdle we must get through.

    this is ho I did it
    -------
    Background: Honours medical student from UK, recently sat USMLe Step 1 and 2. I read some of Kalra when I was a medical student.

    Exam Preparation: I studied what other people with very high scores did and I did likewise, hoping to pass. I only had 3 weeks to prepare and during this time I wasn't working.

    1) Did all onexamination past questions and made notes on the ones I got wrong.
    2) Looked up common topics in Kalra
    3) Read entire chapters of Kalra, taking brief notes

    YOU DO NOT NOT NEED TO READ BIG BOOKS TO PASS THIS EXAM!!

    Please dont waste time reading Kumar and Clarke and Davidsons
    I also had the MRCP Masterclass but did not use it - It was too heavy going..

    I had a borderline score on my fist attempt at onexamination
    My score was in the 70's on the second attempt.
    -------
    What got me through?

    1) onexamination teaches the common topics and the correct way of thinking
    2) I followed the advice of people who did well - so even if I did 50% the same as them, I would probably pass.

    -------------
    Comment
    1. Other candidated during the exam seemed to be very pleased to finish with a lot of time to spare - I think tis reflects the unwholesome culture in the nhs - this as everything else is not a race - take your time in the exam- as long as you finish all the questions.

    2. The english deliberately put barriers in the way - emphasising subtle language in the mcq's - which has nothing to do with being a good doctor. As far as I can see this is only to keep foreign doctors out.. Their latest ploy appears to be adding lots basic science questions in e.g. genetics to put a bias on their local gradates,

    Conclusion
    to pass the exam onexamination (past papers), Kalra

    PS. my 100 commomly tested facts list was very high yield for the exam. Please check for factual innacuracies.
  9. Guest

    Guest Guest

    passing part 1

    i like your tactics and well done on passing 1st time.....silly question: how did you find out how other high-scoring candidates achieved their success?

    as a currently-unemployed SHO (locuming in A+E) with no friends who are doctors, i have no contact with other people who're studying for MRCP so can't find out what tactics other people employ.
  10. Guest

    Guest Guest

    re. high scoring tactics

    hi there. the best way to find successful tactics these days is to scour the nlinw forums. This helps no end and has worked for me for USMLE Step 1 and 2 and MRCP part 1.

    try a few forms and do some searches i.e. mcqs.com etc...

    what it boils down to for mrcp part 1 is

    1) do onexamination.com
    2) read round commonly tested facts

    good luck!
  11. Guest

    Guest Guest

    mock test

    is there any tools or mock test available?
  12. Guest

    Guest Guest

    Hi Shyam,mock tests are available on this very website..in the mrcp section
  13. Guest

    Guest Guest

    reply

    thanks
    what a collection of important facts?
  14. Guest

    Guest Guest

    Drug induced SLE (DILE)

    Antihistone antibodies rare but specific
    Anti-dsDNA present
    Complement C3/C4 levels decrease
    Cutaneous findings in >75%
    Raynaud phenomenon in 50%
    Hydralazine-induced DILE has association with HLA-DR4.


    Antiarrhythmics - Procainamide and quinidine
    Antibiotics - Minocycline, isoniazid, and griseofulvin
    Anticonvulsants - Valproate, ethosuximide, carbamazepine, and hydantoins
    Hormonal therapy - Leuprolide acetate
    Antihypertensives - Hydralazine, methyldopa, and captopril
    Anti-inflammatories - D-penicillamine and sulfasalazine
    Antipsychotics - Chlorpromazine
    Cholesterol-lowering agents - Lovastatin, simvastatin, and gemfibrozil
  15. Guest

    Guest Guest

    Polyglandular Autoimmune Syndrome

    Polyglandular Autoimmune Syndrome

    PGA syndrome type I (PGA-I), (APECED or Whitaker syndrome) is:

    candidiasis, hypoparathyroidism, and adrenal failure.

    PGA syndrome type II:
    Addison disease plus type 1 DM + hypogonadism, pernicious anemia, celiac disease.


    PGA syndrome type III: 2 of the following:

    thyroid deficiency, pernicious anemia, insulin-requiring diabetes, vitiligo, and alopecia.
  16. Guest

    Guest Guest

    MEN

    MEN 1
    affects the parathyroid glands, the pancreatic islets and the anterior pituitary

    MEN 2 (MEN 2A)
    medullary thyroid carcinoma (MTC), pheochromocytoma and parathyroid tumours.

    MEN 3(MEN 2B)
    resembling MEN 2, except that parathyroid hyperplasia is rare.
  17. re. mrcp commonly tested facts

    Thanks everyone for your contributions I think a summary of MEn syndromes should be added to thus list....but i dont have time right now and the version I see posted has no mention of mucosal neuromas....

    OK I UPDATED MY LIST OF 50 AND ADDED CORRECTIONS

    PLEASE GIVE CORRECTIONS AND ADDITIONS ONLY

    ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ON OFFICIAL PAST MRCP QUESTIONS

    1. Acromegaly – Diagnosis: OGTT followed by GH conc.
    2. Cushings – Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen.
    3. Rash on buttocks – Dermatitis herpetiformis (coeliac dx).
    4. AF with TIA --> Warfarin. Just TIA's with no AF --> Aspirin
    5. Herpes encephalitis --> temporal lobe calicification OR temporoparietal attentuation – subacute onset i.e. Several days.
    6. Obese woman, papilloedema/headache --> Benign Intercanial Hypertention.
    7. Drug induced pneumonitis --> methotrexate or amiodarone.
    8. chest discomfort and dysphagia --> achalasia.
    9. foreign travel, macpap rash/flu like illnes --> HIV acute.
    10. cause of gout --> dec urinary excretion.
    11. bullae on hands and fragule skin torn by minor trauma --> porphyria cutanea tarda.
    12. Splenectomy --> need pneumococcal vaccine AT LEAST 2 weeks pre-op and for life.
    13. primary hrperparathyroidism --> high Ca, normal/low PO4, normal/high PTH (in elderly).
    14. middle aged man with KNEE arthritis --> gonococcal sepsis (older people -> Staph).
    15. sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome benign, no Rx needed.
    16. tremor postural,slow progression,titubation, relieved by OH->benign essential tremor AutDom. (MS – titbation, PD – no titubation)
    17. electrolytes disturbance causing confusion – low/high Na.
    18. contraindications lung surgery --> FEV <1.5, MALIGNANT effusion, mets outside lung.
    19. prevent further renal deterioration/proteinuria--> dec bp 130/90, Ace inhibitors (if proteinuria <3g/24hrs)
    20. headache with many analgesics at once -> analgesic induced headache.
    21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance angiogram.
    22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion.
    23. severe retroorbital, daily headache, lacrimation --> cluster headache.
    24. pemphigus – involves mouth (mucus membranes), pemphigoid – less serious NOT mucosa.
    25. diagnosis of polyuria -> water deprivation test, then DDAVP.
    26. insulinoma -> 24 hr supervised fasting hypoglycaemia.
    27. Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT.
    28. causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig, lymphoma, trop sprue (rx tetracycline).
    29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets.
    30. hepatitis B with general deterioration -> hepaocellular carcinoma.
    31. albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis).
    32. HBSag positive, HB DNA not detectable --> chornic carier.
    33. Inf MI, artery invlived -> Right coronary artert.
    34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, familial hyperchol,Gilberts, Huntington's, Marfans's, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers.
    35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B.
    36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR.
    37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2.
    38. 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.
    39. MVP sudden worsening post MI. Harsh systolic murmur radites to axilla.
    40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia.
    41. Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy, radiotherapy, toxins.
    42. Tumor compressing Respiratory tract --> investigation: flow volume loop.
    43. Guillan Barre syndrome: check VITAL CAPACITY.
    44. Horners – sweating lost in upper face only – lesion proximal to common carotid artery.
    45. 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.
    46. Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal dolls eye. i.e. Occulomotor nuclei intact, supranuclear pathology.
    47. Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS.
    48. demetia, gait abnormaily, urinary incontinence. Absent papilloedema-->Normal pressure hydrocephalus.
    49. acute red eye -> acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcleritis, subconjuntival haemmorrhage).
    50. wheeles, urticaria, drug induced -> aspirin.
    51. sweats and weight gain -> insulinoma.
    52. diagnostic test for asthma -> morning dip in PEFR >20%.
    53. Causes of SIADH : chest/cerebral/pancreas pathology, porphyria, malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs, rifampicin, opiates)
    54. Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma Nephrogenic: Lithium, amphoteracin, domeclocycline, prologed hypercalcaemia/hypornatraemia, familial X linked type
    55. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vitamin D also).
    56.returned from airline flight, TIA-> paradoxical embolus do TOE.
    57. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff.
    58. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute.
    59. painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven otherwise
    60 late complication of scleroderma --> pumonaryhypertention plus/minus fibrosis.
    61. causes of erythema mutliforme: lamotrigine
    62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically abnormal in this setting DO NOT give thyroxine).
    63. mouth/genital ulcers and oligarthritis -> behcets (also eye/skin lesions, DVT)
    64. mixed drug overdose most important step -> Nacetylcysteine (time dependent prognosis)
    65. cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling, conj injectn
    66. asymetric parkinsons -> likely to be idiopathic
    67. Obese, NIDDM female with abnormal LFT's -> NASH (non-alcoholic steatotic hepatitis)
    68. fluctuating level of conciousness in elderly plus/minus deterioration --> chronic subdural. Can last even longer than 6 months
    69. Sensitivity --> TP/(TP plus FN) e.g. For SLE - ANA highly sens, dsDNA:highly specific
    70. RR is 8%. NNT is ----> 100/8 --> 50/4 --> 25/2 --> 13.5
    71. ipsilateral ataxia, Horners, contralateral loss pain/temp --> PICA stroke (lateral medulary syndrome of Wallenburg)
    72. renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric acid and cyteine stone are radioluscent.
    73. hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Da antags (metoclopramide, chlorpromazine, cimetidine NOT TCA's), pregnancy, PCOS, pit tumor/microadenoma, stress.
    74. Distal, asymetric arthropathy -> psoriasis
    75. episodic headache with tachycardia -> phaeochromocytoma
    76. very raised WCC -> ALWAYS think of leukaemia.
    77. Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT bone marrow
    78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at diagnosis.
    79. pancytopenia with raised MCV --> check B12/folate first (other causes possble, but do this FIRST). Often associayed with phenytoin use --> decreased folate
    80. miscariage, DVT, stroke --> lupus anticoagulant --> lifelong anticoagulation
    81. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
    82. anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic hypogonadism)
    83. diag of PKD -> renal US even if <30, linkage analysis BUT requires serum from 2 relatives with dx
    84. Young female -> think anorexia nervosa
    85. commonest finding in G6PD hamolysis -> haumoglobinuria
    86. mitral stenosis: loud S1 (soft s1 if severe), opening snap.. Immobile valve -> no snap.
    87. 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)
    88. anaemia in the elderly assume GI malignancy
    89. hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)
    90. pain, numbness lateral upper thigh --> meralgia paraesthesia (lat cutaneous nerve compression usally by by ing ligament)
    91. diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrin saturation, genotyping. If nondiagnostic do liver biopsy 0.3% mortality
    92. 40 mg hidrocortisone divided doses (bd) --> 10 mg prednisolone (ie. Prednislone is x4 stronger)
    93. BTS: TB guidlines – close contacts -> Heaf test -> positive CXR, negative --> repeat Heaf in 6 weeks. Isolation not required.
    94. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity.
    95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles ->>Discoid lupus
    96. wt loss, malabsoption, inc ALP -> pancreatic cancer
    97. foreign travel, tender RUQ, raised ALP --> liver abscess do U/S
    98. wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoea does NOT have to be present)
    99. haematuria, proteinuria, best investigation --> if glomerulonephritis suspected --> renal biopsy
    100. venous ulcer treatment --> exclude arteriopathy (eg ABPI), control oedema, prevent infection, compression bandaging.
    101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West Africa) longer imcubation.
    102. Fever, lymphadenopathy, lymphocytosis, pharygitis --->EBV ---> heterophile antibodies
    103. GI bleed after endovascular AAA surgery --> aortoenteric fistula

    High Yield Topics
    1. Young girl – suspect Anorexia Nervosa – linugo hair, finctional hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually normal. Ferritin low.
    2. Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Yersinia, Salmonella, Shigella. Balanisits.
    3. PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
    4. Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis
    5. Heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
    6. Vitiligo – commonest assoctions pernicious anaemia >>> type 1 dm, autoimmune addisons, autoimmune thyoid dx
    7. Gout – blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute phase
    8. 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
    9. CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML – demylination in advanced HIV, low attenuation lesions)
    10. Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), salmonella (serious systemic illness), E.coli (rx. Ciprofloxacin) , Shigella
    11. Renal syndrome – minimal change disease, membanous, IgA nephropathy, post-streptococcal.
    12. If you see blood on urinalysis forget about RAS
    13. Thyroid Malignancy – tend to be non-functional, anaplastic has worse prognosis, local infiltration -> dysphagia, vocal cord paralysis

    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)

    PLEASE GIVE CORRECTIONS AND ADDITIONS

    ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ON OFFICIAL PAST MRCP QUESTIONS
  18. re. mrcp commonly tested facts

    Thanks everyone for your contributions I think a summary of MEn syndromes should be added to thus list....but i dont have time right now and the version I see posted has no mention of mucosal neuromas....

    OK I UPDATED MY LIST OF 50 AND ADDED CORRECTIONS

    PLEASE GIVE CORRECTIONS AND ADDITIONS ONLY

    ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ON OFFICIAL PAST MRCP QUESTIONS

    1. Acromegaly – Diagnosis: OGTT followed by GH conc.
    2. Cushings – Diagnosis: 24hr urinary free cortisol. Addisons --> short synacthen.
    3. Rash on buttocks – Dermatitis herpetiformis (coeliac dx).
    4. AF with TIA --> Warfarin. Just TIA's with no AF --> Aspirin
    5. Herpes encephalitis --> temporal lobe calicification OR temporoparietal attentuation – subacute onset i.e. Several days.
    6. Obese woman, papilloedema/headache --> Benign Intercanial Hypertention.
    7. Drug induced pneumonitis --> methotrexate or amiodarone.
    8. chest discomfort and dysphagia --> achalasia.
    9. foreign travel, macpap rash/flu like illnes --> HIV acute.
    10. cause of gout --> dec urinary excretion.
    11. bullae on hands and fragule skin torn by minor trauma --> porphyria cutanea tarda.
    12. Splenectomy --> need pneumococcal vaccine AT LEAST 2 weeks pre-op and for life.
    13. primary hrperparathyroidism --> high Ca, normal/low PO4, normal/high PTH (in elderly).
    14. middle aged man with KNEE arthritis --> gonococcal sepsis (older people -> Staph).
    15. sarcoidosis, erythema nodosum, arthropathy --> Loffgrens syndrome benign, no Rx needed.
    16. tremor postural,slow progression,titubation, relieved by OH->benign essential tremor AutDom. (MS – titbation, PD – no titubation)
    17. electrolytes disturbance causing confusion – low/high Na.
    18. contraindications lung surgery --> FEV <1.5, MALIGNANT effusion, mets outside lung.
    19. prevent further renal deterioration/proteinuria--> dec bp 130/90, Ace inhibitors (if proteinuria <3g/24hrs)
    20. headache with many analgesics at once -> analgesic induced headache.
    21. 1.5 cm difference btwn kidneys -> Renal artery stenosis --> Magnetic resonance angiogram.
    22. temporal tenderness--> temporal arteritis -> steroids > 90% ischaemic neuropathy, 10% retinal art occlusion.
    23. severe retroorbital, daily headache, lacrimation --> cluster headache.
    24. pemphigus – involves mouth (mucus membranes), pemphigoid – less serious NOT mucosa.
    25. diagnosis of polyuria -> water deprivation test, then DDAVP.
    26. insulinoma -> 24 hr supervised fasting hypoglycaemia.
    27. Diabetes Random >7 or if >6 OGTT (75g) -> >11.1 also seen in HCT.
    28. causes of villous atrophy: coeliac (lymphocytic infiltrate), Whipples , dec Ig, lymphoma, trop sprue (rx tetracycline).
    29. diarrhoea, bronchospasm, flushing, tricuspid stenosis -> gut carcinoid c liver mets.
    30. hepatitis B with general deterioration -> hepaocellular carcinoma.
    31. albumin normal, total protein high -> myeloma (hypercalcaemia, electrophoresis).
    32. HBSag positive, HB DNA not detectable --> chornic carier.
    33. Inf MI, artery invlived -> Right coronary artert.
    34. Aut dom conditions: Achondroplasia, Ehler Danlos, FAP, familial hyperchol,Gilberts, Huntington's, Marfans's, NFT I/II, Most porphyrias, tuberous sclerosis, vWD, PeutzJeghers.
    35. X linked: Beck/Duch musc dyst, alports, Fragile X, G6PD, Haemophilia A/B.
    36. Loud S1: MS, hyperdynamic, short PR. Soft S1: immobile MS, MR.
    37. Loud S2: hypertension, AS. Fixed split: ASD. Opening snap: MOBILE MS, severe near S2.
    38. 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.
    39. MVP sudden worsening post MI. Harsh systolic murmur radites to axilla.
    40. Dilated Cardiomyopathy: OH, bp, thiamine/selenium deficiency, MD, cocksackie/HIV, preg, doxorubicin, infiltration (HCT, sarcoid), tachycardia.
    41. Restrictive Cardiomyopathy: sclerodermma, amyloid, sarcoid, HCT, glycogen storage, Gauchers, fibrosis, hypereosinophilia Lofflers, caracinoid, malignancy, radiotherapy, toxins.
    42. Tumor compressing Respiratory tract --> investigation: flow volume loop.
    43. Guillan Barre syndrome: check VITAL CAPACITY.
    44. Horners – sweating lost in upper face only – lesion proximal to common carotid artery.
    45. 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.
    46. Progressive Supranuclear palsy: Steel Richardson. Absent voluntary downward gaze, normal dolls eye. i.e. Occulomotor nuclei intact, supranuclear pathology.
    47. Perinauds syndrome: dorsal midbrain syndrome, damaged midrain and superior colliculus: impaired upgaze (cf PSNP), lid retraction, convergence preserved. Causes: pineal tumor, stroke, hydrocephalus, MS.
    48. demetia, gait abnormaily, urinary incontinence. Absent papilloedema-->Normal pressure hydrocephalus.
    49. acute red eye -> acute closed angle glaucoma >> less common (ant uveitis, scleritis, episcleritis, subconjuntival haemmorrhage).
    50. wheeles, urticaria, drug induced -> aspirin.
    51. sweats and weight gain -> insulinoma.
    52. diagnostic test for asthma -> morning dip in PEFR >20%.
    53. Causes of SIADH : chest/cerebral/pancreas pathology, porphyria, malignancy, Drugs (carbamazepine, chlorpropamide, clofibrate, atipsychotics, NSAIDs, rifampicin, opiates)
    54. Causes of Diabetes Insipidus: Cranial: tumor, infiltration, trauma Nephrogenic: Lithium, amphoteracin, domeclocycline, prologed hypercalcaemia/hypornatraemia, familial X linked type
    55. bisphosphonates:inhibit osteoclast activity, prevent steroid incduced osteoperosis (vitamin D also).
    56.returned from airline flight, TIA-> paradoxical embolus do TOE.
    57. alcoholic, given glucose develops nystagmus -> B1 deficiency (wernickes). Confabulation->korsakoff.
    58. mono-artropathy with thiazide -> gout (neg birefringence). NO ALLOPURINOL for acute.
    59. painful 3rd nerve palsy -> posterior communicating artery aneurysm till proven otherwise
    60 late complication of scleroderma --> pumonaryhypertention plus/minus fibrosis.
    61. causes of erythema mutliforme: lamotrigine
    62. vomiting, abdominal pain, hypothyroidism -> Addisonian crisis (TFT typically abnormal in this setting DO NOT give thyroxine).
    63. mouth/genital ulcers and oligarthritis -> behcets (also eye/skin lesions, DVT)
    64. mixed drug overdose most important step -> Nacetylcysteine (time dependent prognosis)
    65. cavernous sinus syndrome - 3rd nerve palsy, proptosis, periorbital swlling, conj injectn
    66. asymetric parkinsons -> likely to be idiopathic
    67. Obese, NIDDM female with abnormal LFT's -> NASH (non-alcoholic steatotic hepatitis)
    68. fluctuating level of conciousness in elderly plus/minus deterioration --> chronic subdural. Can last even longer than 6 months
    69. Sensitivity --> TP/(TP plus FN) e.g. For SLE - ANA highly sens, dsDNA:highly specific
    70. RR is 8%. NNT is ----> 100/8 --> 50/4 --> 25/2 --> 13.5
    71. ipsilateral ataxia, Horners, contralateral loss pain/temp --> PICA stroke (lateral medulary syndrome of Wallenburg)
    72. renal stones (80% calcium, 10% uric acid, 5% ammonium (proteus), 3% other). Uric acid and cyteine stone are radioluscent.
    73. hyperprolactinaemia (allactorrohea, amenorrohea, low FSH/LH) -> Da antags (metoclopramide, chlorpromazine, cimetidine NOT TCA's), pregnancy, PCOS, pit tumor/microadenoma, stress.
    74. Distal, asymetric arthropathy -> psoriasis
    75. episodic headache with tachycardia -> phaeochromocytoma
    76. very raised WCC -> ALWAYS think of leukaemia.
    77. Diagnosis of CLL --> immunophenotyping NOT cytogenetics, NOT bone marrow
    78. Prognostic factors for AML -> bm karyotype (good/poor/standard) >> WCC at diagnosis.
    79. pancytopenia with raised MCV --> check B12/folate first (other causes possble, but do this FIRST). Often associayed with phenytoin use --> decreased folate
    80. miscariage, DVT, stroke --> lupus anticoagulant --> lifelong anticoagulation
    81. Hb elevated, dec ESR -> polycythaemua (2ndry if paO2 low)
    82. anosmia, delayed puberty -> Kallmans syndrome (hypogonadotrophic hypogonadism)
    83. diag of PKD -> renal US even if <30, linkage analysis BUT requires serum from 2 relatives with dx
    84. Young female -> think anorexia nervosa
    85. commonest finding in G6PD hamolysis -> haumoglobinuria
    86. mitral stenosis: loud S1 (soft s1 if severe), opening snap.. Immobile valve -> no snap.
    87. 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)
    88. anaemia in the elderly assume GI malignancy
    89. hypothermia, acute renal failure -> rhabdomyolysis (collapse assumed)
    90. pain, numbness lateral upper thigh --> meralgia paraesthesia (lat cutaneous nerve compression usally by by ing ligament)
    91. diagnosis of haemochromatosis: screen with Ferritin, confirm by tranferrin saturation, genotyping. If nondiagnostic do liver biopsy 0.3% mortality
    92. 40 mg hidrocortisone divided doses (bd) --> 10 mg prednisolone (ie. Prednislone is x4 stronger)
    93. BTS: TB guidlines – close contacts -> Heaf test -> positive CXR, negative --> repeat Heaf in 6 weeks. Isolation not required.
    94. Diptheria -> exudative pharyngitis, lymphadenopathy, cardio and neuro toxicity.
    95. Indurated plaques on cheeks, scarring alopecia, hyperkeratosis over hair follicles ->>Discoid lupus
    96. wt loss, malabsoption, inc ALP -> pancreatic cancer
    97. foreign travel, tender RUQ, raised ALP --> liver abscess do U/S
    98. wt loss, anaemia (macro/micro), no obvious cause -> coeliac (diarrhoea does NOT have to be present)
    99. haematuria, proteinuria, best investigation --> if glomerulonephritis suspected --> renal biopsy
    100. venous ulcer treatment --> exclude arteriopathy (eg ABPI), control oedema, prevent infection, compression bandaging.
    101. Malaria, incubation within 3/12. can be relapsing /remitting. Vivax and Ovale (West Africa) longer imcubation.
    102. Fever, lymphadenopathy, lymphocytosis, pharygitis --->EBV ---> heterophile antibodies
    103. GI bleed after endovascular AAA surgery --> aortoenteric fistula

    High Yield Topics
    1. Young girl – suspect Anorexia Nervosa – linugo hair, finctional hypogonadotrophic hypogonadism -> amennorhea. LH and FSH both low. All other hormones are usually normal. Ferritin low.
    2. Reiters Syndrome – arthritis, uveitis, urethritis – Chlymidia, campylobacter, Yersinia, Salmonella, Shigella. Balanisits.
    3. PKD – aut dom Chr 16/4 assoc berry aneurysm, mitral/aortic regurg
    4. Porphyria – photosensitivity, blisters, scars with millia, hypertrichosis
    5. Heart sounds: Aortic Stenosis s2 paradoxical split, length proportional to severity
    6. Vitiligo – commonest assoctions pernicious anaemia >>> type 1 dm, autoimmune addisons, autoimmune thyoid dx
    7. Gout – blood urate high/low/normal, joint aspirate pos birif, ppt thiazides, NO allopurinol/aspirin in acute phase
    8. 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
    9. CNS abnormalities in HIV: toxoplaasmosis (ring enhancing), lymphoma (solitary lesion). HIV encephalopathy, progressive multifocal leucoencephalopathy (PML – demylination in advanced HIV, low attenuation lesions)
    10. Travellers diarrohea: chronic (>2 WEEKS) giardia (incidious onset rx. Metronidazole), salmonella (serious systemic illness), E.coli (rx. Ciprofloxacin) , Shigella
    11. Renal syndrome – minimal change disease, membanous, IgA nephropathy, post-streptococcal.
    12. If you see blood on urinalysis forget about RAS
    13. Thyroid Malignancy – tend to be non-functional, anaplastic has worse prognosis, local infiltration -> dysphagia, vocal cord paralysis

    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)

    PLEASE GIVE CORRECTIONS AND ADDITIONS

    ONLY INCLUDE FACTS THAT HAVE FREQUENTLY APPEARED ON OFFICIAL PAST MRCP QUESTIONS
  19. Guest

    Guest Guest

  20. new guest

    new guest Guest

    mrcp-1

    is any one appearing for mrcp-1 in jan2006
  21. sawsan s

    sawsan s Guest

    the fact of 'most common' and 'typically'

    Hi, these are some statistical facts which can be useful for the exam

    **Fibrosing alveolitis is the most common pulmonary manifestation of rheumatoid arthritis.

    **impairment in renal function in Hepatorenal syndrome The hallmark is oliguria and progressive decline in renal function. The urine is typically free of protein or any other sediment.

    **Long-term haemodialysis is associated with carpal tunnel syndrome. is the most common complication

    **the most likely cause of bacterial meningitis in adult patients with neutropenia :
    Listeria monocytogenes.

    **the most frequent cause of a nosocomial wound infection: Insufficient hand disinfection

    **Osteoporosis is the most common cause of fracture of neck of femur and is not associated with any specific abnormality in the standard bone biochemistry profile.

    **Tuberculous arthritis usually affects children aged 2–5 years. The hip is one of the most frequently affected joints.

    **Meningitis due to enterovirus and meningococcus (N. meningitidis) are the most likely in this age group(28 yrs0

    **Tuberculous meningitis is rare in the UK and the CSF typically shows a markedly raised protein (> 1 g/l), a low glucose (< 50% serum) and a lymphocytosis.

    **Streptococcus meningitis is the commonest cause of meningitis in those over 40 years of age; very high neutrophil counts are often seen in the CSF, which has a high protein and low glucose level.

    **Factors predisposing to digitalis toxicity are advanced age, hypoxia, hypokalaemia, hypomagnesaemia, hypercalcaemia, hypothyroidism, amyloidosis and renal failure. The most common precipitating factor is hypokalaemia.

    ** In Hodgkin’s disease Lymphocyte depleted has the worst prognosis. It is the least common variant and typically occurs in older people.

    **The commonest mutation in patients with cystic fibrosis (CF) is the Delta-F508 mutation.

    **in systemic lupus erythematosus Recurrent pleurisy and pleural effusions are the most common manifestations and are often bilateral

    **Cryptosporidium infection in HIV-positive patients along with cytomegalovirus, is the commonest cause of HIV-related diarrhoea and tends to present when the CD4 count is less than 100.

    **Diarrhoea and flushing, occurring separately or together, are the most frequent presenting features of carcinoid syndrome (approximately half of all patients).

    **Focal necrotising glomerulonephritis is the characteristic renal lesion of generalised Wegener’s granulomatosis. Typically, it presents with deteriorating renal function that progresses to renal failure within 3 months,

    **Glomerulonephritis is a common occurrence in chronic Schistosoma mansoni infection in Brazil, especially in patients with hepatosplenic disease

    **Tremor in the legs is a useful sign as it is almost always associated with idiopathic Parkinson’s disease. The tremor is typically a rest tremor unlike benign essential tremor, where actions such as drinking a cup of tea make the tremor worse.

    **Pericardial effusions are more common in patients with rheumatoid arthritis than constrictive pericarditis and acute pericarditis.

    **The earliest lesions to be detected in diabetic retinopathy are usually dot haemorrhages (capillary microaneurysms) and venous dilatation.

    **Hypertrophic cardiomyopathy is the single, most common cause of sudden death in young athletes.

    **the most common cause of paranoid psychosis with visual hallucination :Alcohol withdrawal

    **Basal cell carcinomas are the most common malignant skin tumour and are related to excessive skin exposure. They are common later in life and may present as a slow-growing nodule or papule.

    **The most common type of thyroid cancer is papillary cancer, which accounts for approximately 70% of all thyroid cancers


    Good luck :)
  22. sawsan s

    sawsan s Guest

    the fact of 'most common' and 'typically'

    Hi, these are some statistical facts which can be useful for the exam

    **Fibrosing alveolitis is the most common pulmonary manifestation of rheumatoid arthritis.

    **impairment in renal function in Hepatorenal syndrome The hallmark is oliguria and progressive decline in renal function. The urine is typically free of protein or any other sediment.

    **Long-term haemodialysis is associated with carpal tunnel syndrome. is the most common complication

    **the most likely cause of bacterial meningitis in adult patients with neutropenia :
    Listeria monocytogenes.

    **the most frequent cause of a nosocomial wound infection: Insufficient hand disinfection

    **Osteoporosis is the most common cause of fracture of neck of femur and is not associated with any specific abnormality in the standard bone biochemistry profile.

    **Tuberculous arthritis usually affects children aged 2–5 years. The hip is one of the most frequently affected joints.

    **Meningitis due to enterovirus and meningococcus (N. meningitidis) are the most likely in this age group(28 yrs0

    **Tuberculous meningitis is rare in the UK and the CSF typically shows a markedly raised protein (> 1 g/l), a low glucose (< 50% serum) and a lymphocytosis.

    **Streptococcus meningitis is the commonest cause of meningitis in those over 40 years of age; very high neutrophil counts are often seen in the CSF, which has a high protein and low glucose level.

    **Factors predisposing to digitalis toxicity are advanced age, hypoxia, hypokalaemia, hypomagnesaemia, hypercalcaemia, hypothyroidism, amyloidosis and renal failure. The most common precipitating factor is hypokalaemia.

    ** In Hodgkin’s disease Lymphocyte depleted has the worst prognosis. It is the least common variant and typically occurs in older people.

    **The commonest mutation in patients with cystic fibrosis (CF) is the Delta-F508 mutation.

    **in systemic lupus erythematosus Recurrent pleurisy and pleural effusions are the most common manifestations and are often bilateral

    **Cryptosporidium infection in HIV-positive patients along with cytomegalovirus, is the commonest cause of HIV-related diarrhoea and tends to present when the CD4 count is less than 100.

    **Diarrhoea and flushing, occurring separately or together, are the most frequent presenting features of carcinoid syndrome (approximately half of all patients).

    **Focal necrotising glomerulonephritis is the characteristic renal lesion of generalised Wegener’s granulomatosis. Typically, it presents with deteriorating renal function that progresses to renal failure within 3 months,

    **Glomerulonephritis is a common occurrence in chronic Schistosoma mansoni infection in Brazil, especially in patients with hepatosplenic disease

    **Tremor in the legs is a useful sign as it is almost always associated with idiopathic Parkinson’s disease. The tremor is typically a rest tremor unlike benign essential tremor, where actions such as drinking a cup of tea make the tremor worse.

    **Pericardial effusions are more common in patients with rheumatoid arthritis than constrictive pericarditis and acute pericarditis.

    **The earliest lesions to be detected in diabetic retinopathy are usually dot haemorrhages (capillary microaneurysms) and venous dilatation.

    **Hypertrophic cardiomyopathy is the single, most common cause of sudden death in young athletes.

    **the most common cause of paranoid psychosis with visual hallucination :Alcohol withdrawal

    **Basal cell carcinomas are the most common malignant skin tumour and are related to excessive skin exposure. They are common later in life and may present as a slow-growing nodule or papule.

    **The most common type of thyroid cancer is papillary cancer, which accounts for approximately 70% of all thyroid cancers


    Good luck :)
  23. Guest

    Guest Guest

    thanks alot
  24. sawsan s

    sawsan s Guest

    new additions

    **Fibrosing alveolitis is the most common pulmonary manifestation of rheumatoid arthritis.

    **impairment in renal function in Hepatorenal syndrome The hallmark is oliguria and progressive decline in renal function. The urine is typically free of protein or any other sediment.

    **Long-term haemodialysis is associated with carpal tunnel syndrome. is the most common complication

    **the most likely cause of bacterial meningitis in adult patients with neutropenia :
    Listeria monocytogenes.

    **the most frequent cause of a nosocomial wound infection: Insufficient hand disinfection

    **Osteoporosis is the most common cause of fracture of neck of femur and is not associated with any specific abnormality in the standard bone biochemistry profile.

    **Tuberculous arthritis usually affects children aged 2–5 years. The hip is one of the most frequently affected joints.

    **Meningitis due to enterovirus and meningococcus (N. meningitidis) are the most likely in this age group(28 yrs0

    **Tuberculous meningitis is rare in the UK and the CSF typically shows a markedly raised protein (> 1 g/l), a low glucose (< 50% serum) and a lymphocytosis.

    **Streptococcus meningitis is the commonest cause of meningitis in those over 40 years of age; very high neutrophil counts are often seen in the CSF, which has a high protein and low glucose level.

    **Factors predisposing to digitalis toxicity are advanced age, hypoxia, hypokalaemia, hypomagnesaemia, hypercalcaemia, hypothyroidism, amyloidosis and renal failure. The most common precipitating factor is hypokalaemia.

    ** In Hodgkin’s disease Lymphocyte depleted has the worst prognosis. It is the least common variant and typically occurs in older people.

    **The commonest mutation in patients with cystic fibrosis (CF) is the Delta-F508 mutation.

    **in systemic lupus erythematosus Recurrent pleurisy and pleural effusions are the most common manifestations and are often bilateral

    **Cryptosporidium infection in HIV-positive patients along with cytomegalovirus, is the commonest cause of HIV-related diarrhoea and tends to present when the CD4 count is less than 100.

    **Diarrhoea and flushing, occurring separately or together, are the most frequent presenting features of carcinoid syndrome (approximately half of all patients).

    **Focal necrotising glomerulonephritis is the characteristic renal lesion of generalised Wegener’s granulomatosis. Typically, it presents with deteriorating renal function that progresses to renal failure within 3 months,

    **Glomerulonephritis is a common occurrence in chronic Schistosoma mansoni infection in Brazil, especially in patients with hepatosplenic disease

    **Tremor in the legs is a useful sign as it is almost always associated with idiopathic Parkinson’s disease. The tremor is typically a rest tremor unlike benign essential tremor, where actions such as drinking a cup of tea make the tremor worse.

    **Pericardial effusions are more common in patients with rheumatoid arthritis than constrictive pericarditis and acute pericarditis.

    **The earliest lesions to be detected in diabetic retinopathy are usually dot haemorrhages (capillary microaneurysms) and venous dilatation.

    **Hypertrophic cardiomyopathy is the single, most common cause of sudden death in young athletes.

    **the most common cause of paranoid psychosis with visual hallucination :Alcohol withdrawal

    **Basal cell carcinomas are the most common malignant skin tumour and are related to excessive skin exposure. They are common later in life and may present as a slow-growing nodule or papule.

    **The most common type of thyroid cancer is papillary cancer, which accounts for approximately 70% of all thyroid cancers

    ***Open angle glaucoma is 100 times more common than angle closure glaucoma, and is asymptomatic until central visual loss appears at the end stage.

    **a high white cell count with smear cells and mature lymphocytes. This is characteristic of chronic lymphocytic leukaemia...

    **Chronic lymphocytic leukaemia
    · Constitutes 25% of all leukaemias. It is chiefly a disease of the elderly
    · It is characterised by an accumulation of mature lymphocytes in the peripheral blood, bone marrow, spleen, liver and lymph nodes
    · Clinical findings include painless, symmetrical lymphadenopathy, hepatosplenomegaly, pruritus and symptoms due to bone marrow failure
    · Blood film will show large numbers of mature lymphocytes and smear or smudge cells. Anaemia and thrombocytopenia are common
    · Hypogammaglobulinaemia is common and monoclonal paraproteins are occasionally seen
    · Staging is by the Binet or Rai systems and depends on number of areas involved and full blood count results
    · Median survival is 3–5 years and one-third die of causes other than the leukaemia
    · In early stages no treatment is required. In later stages and in rapidly progressive disease treatment is with oral or intravenous chemotherapy such as chlorambucil or fludarabine. Stem cell transplantation is an option in younger patients


    **IgG is the most common paraprotein in myeloma.

    **Myeloma
    · Median age of diagnosis is 70 years
    · Diagnosis is made in the presence of two of monoclonal protein in blood or urine, 10% plasma cells in bone marrow and lytic bone lesions
    · Other clinical features are bone disease, hypercalcaemia, renal failure, bone marrow failure and immune paresis
    · 5 year survival is only 25%
    · Treatment is supportive, chemotherapy (which can be oral or intravenous) and autologous or allogeneic stem cell transplantation
    · Thalidomide has recently been used in relapsed and refractory disease


    ***Adrenergic inhibitors used in hypertension:
    Peripheral neuronal inhibitors: Reserpine, Guanethedine
    Central adrenergic inhibitors: M-dopa, Clonidine, Guananbenz, Guanafacine
    Alpha-receptor blockers:
    o Alpha 1 and 2 receptor blockers: Phenoxybenzamine, phentolamine
    o Alpha 1 blockers: Doxazosin, Terazosin
    Beta blockers
    Alpha and beta blockers: Labetalol

    **Polycythaemia rubra vera:
    · Splenomegaly
    · Aquagenic pruritus
    · Bleeding
    · Gout
    · Peptic ulcer
    · Conversion to myelofibrosis or leukaemia in 10%


    **Causes of Chorea
    Neurodegenerative: Huntington’s disease
    Benign hereditary chorea
    Dentatorubropallidoluysian atrophy
    Inherited metabolic: Wilson’s disease
    Lesch-Nyhan disease
    Neuroacanthosis
    Hypoxic/ischaemic: Stroke
    Hypotension
    Vasculitis Sickle cell disease
    Polycythaemia
    Toxic: Copper
    Mercury
    Drug induced: Oral contraceptive pill
    L-Dopa
    Neuroleptics
    Anticholinergics
    Cocaine
    Amphetamines
    Infection: Sydenham’s chorea
    Meningitis
    Viral encephalitis
    Mycoplasma pneumoniae
    Legionella
    Toxoplasmosis
    Creutzfeld-Jacob disease
    Autoimmune: SLE
    Primary anti-phospholipid syndrome
    Vasculitis Behcet’s
    Hashimoto’s thyroiditis (unrelated to hyperthyroidism)
    Endocrine: Thyrotoxicosis
    Chorea gravidarum
    Addison’s disease
    Metabolic: Hypocalcaemia
    Hypomagnesaemia
    Hyper/hypoglycaemia
    Hyper/hyponatraemia


    **Causes of sudden cardiac death
    · Arrhythmia
    -Acute myocardial infarction
    -Long-QT syndromes
    -Hypertrophic cardiomyopathy
    -Commotio cardis
    -Coronary anomalies
    -Myocarditis
    · Obstruction
    -Atrial myxoma
    -Infective endocarditis
    -Dissection


    **In Hypertrohpic Cardiomyopathy
    · Combination of palpable LVS4 and then double systolic apical impulse due to the mid systolic outflow obstruction
    · It increases in phase II of the valsalva maneouver (the straining phase) and decreases in phase IV (post release phase)
    · Severe diastolic dysfunction
    · Children have a worse prognosis than affected adults because of greater incidence of SCD
    · As in severe AS (because of greater myocardial oxygen demand)


    **5 histological stages have been described (WHO Classification) and treatment depends on this. There is a lack of clear correlation between clinical manifestations and the severity of renal involvement. Biopsy findings guide the selection of immunosuppressive therapy.

    WHO Classification of Lupus Nephritis

    Stage I ¡V Lupus nephritis without histological changes
    Stage II ¡V Mesangial lupus nephritis
    Stage III ¡V Focal proliferative lupus nephritis
    Stage IV ¡V Diffuse proliferative lupus nephritis (commonest & most severe form)
    Stage V ¡V Membranous lupus nephritis


    Conditions that recur in the transplanted kidney

    Focal glomerulosclerosis
    Mesangiocapillary glomerulonephritis
    Rapidly progressive (Crescentic) glomerulonephritis
    IgA nephropathy
    Alport¡¦s syndrome
    Cystinosis
    Oxalosis
    Lupus nephritis
    Goodpastures syndrome
    Wegner¡¦s granulomatosis



    **The most common renal disease in HIV is collapsing FSGS in which there is focal sclerosis associated with collapse down of the glomerulus leaving a space in Bowman’s capsule. It has a poor prognosis and usually leads to ESRF.


    **The indications for a native nephrectomy prior to renal transplant are:
    1. Uncontrolled hypertension where a differential renin study shows that one or the other kidney is significantly contributing to hypertension
    2. Pyonephrosis
    3. Recurrent attacks of clinically significant UTI


    **Budd Chiari classically results in a very high protein ascites but may cause a transudate.

    **Transudates (protein < 30gdl or 75% of the serum albumin) are due to:
    - Reduced intravascular oncotic pressure (hypoalbuminaemia)
    - Increased intravascular hydrostatic pressure (cirrhosis, portal hypertension, CCF)


    **Teaching Notes for Question 15
    Theme: Pancreatic Secretion

    The roles of individual gut hormones are not completely defined, but
    cholecystokinin (duodenum & jejunum) increases gall bladder contraction, increases colonic motility.
    Gastrin (gastric antrum & duodenum) increases gastric acid secretion,increases GI mucosal growth.
    Secretin(duodenum & Jejunum) increases pancreatic bicarbonate production.
    VIP(enteric nerves)increased intestinal secretion, splanchnic vasodilation.
    Motilin(whole gut) increases small bowel motility.
    Bombesin (gut & Pancreas)stimulates pancreatic exocrine activity.

    Neuropeptide Y (enteric nerves)regulates intestinal blood flow.

    Somatostatin (stomach & pancreas) inhibits secretion and action of gut hormones.
    Glucagon(pancreas)reduces GI motility


    **In systemic lupus erythematosus (SLE). Joint involvement is the most common clinical feature (> 90%).

    **Prolactinoma is the commonest pituitary tumour, making up 30% of all adenomas. Microadenomas occur with increasing frequency in women, macroadenomas more commonly in men.

    **ASDs account for about 10-15% of all congenital cardiac anomalies and are the second commonest congenital heart disease seen in adults.

    **VSDs are the commonest adult congenital heart disease.

    **Frontal lobe dementia------>a failure to generate list rapidly is the test of frontal lobe+difficulties with task sequencing and executive skills. EXPRESSIVE aphasia, primitive reflexes, perseveration, anosmia and changes in personality.

    Parietal lobe--------------->Dyscalculia(inability to perform mentalarithmetic) is a manifestation of the dominant parietal lobe
    Sensory inattention, apraxia, neglect, astereognosis(unable to recognise an object by feeling it) and visual field defects( typically homonymous inferior quadrantanopia).

    Temporal lobe-----------> typical homonymous superior quadrantanopia), Wernike's (RECEPTIVE) aphasia, auditory agnosia, and memory impairment

    Occipital lobe---------->cortical blindness(blindness due to damage to the visual cortex and may present as Anton syndrome where there is blindness but the patient is unaware or denies blindness), homonymous hemianopia, and visual agnosia( seeing but not percieving objects - it is diffirent to neglect since in agnosia the objects are seen and followed but cannot be named).

    Homonymous hemianopia----------> occipital lobe
    superior quanranopia---------------->temporal lobe
    inferior quanrtanopia------------------->parietal lobe

    **AUTOIMMUNE ASSOCIATIONS
    Thyroid disease, IDDM, Addison disease, pernicious anaemia, alopecia, vitiligo.

    MULTIPLE ENDOCRINE NEOPLASIA
    Autosomal dominant. The association of a number of endocrine tumours.

    MEN I MEN IIa
    Parathyroid Adrenal (phaeochromocytoma, Cushing)
    Pituitary (prolactin or GH or ACTH) Thyroid (medullary carcinoma)
    Pancreas Parathyroid hyperplasia
    (Thyroid)
    (Adrenal)
    Fasting calcium level (??) Calcitonin level ? (medullary ca. thyroid)
    Look for phaeochromocytoma



    MEN IIb is the same as MEN IIa, with Marfanoid features and multiple neuromas.

    Prophylactic total thyroidectomy is performed if the child is known to carry the gene for MEN II.

    **Adrenergic inhibitors used in hypertension:
    Peripheral neuronal inhibitors: Reserpine, Guanethedine
    Central adrenergic inhibitors: M-dopa, Clonidine, Guananbenz, Guanafacine
    Alpha-receptor blockers:
    o Alpha 1 and 2 receptor blockers: Phenoxybenzamine, phentolamine
    o Alpha 1 blockers: Doxazosin, Terazosin
    Beta blockers
    Alpha and beta blockers: Labetalol

    **Mixed connective tissue disease (MCTD) is an overlap connective tissue disease with features of SLE, polymyositis and progressive systemic sclerosis. The characteristic auto-antibody pattern is of high titre anti-RNP and speckled pattern ANA.

    **The antiphospholipid syndrome is one of the commoner causes of hypoadrenalism and may precipitate adrenal infarction and haemorrage through adrenal vein thrombosis.

    **Biphasic high amplitude sharp waves are characteristic of ceutzfeld-jacob disease.

    **Causes of dilated pupils: Holme's adie(myotonic pupils)
    Third nerve palsy
    drug poisons(atropine, CO, Ethylene glycol)

    Causes of small pupils : horner;s syndrome
    old age
    pontine haemorrhage
    Argyl Robertson pupil
    Drug poisons(opiate, organophosphate)

    **Optic neuropathy------------->central scotoma.
    Optic tract lesion--------------->incongrous homontmous hemianopia.
    Chiasmal lesion---------------->bitemporal hemianopia.
    optic radiation and occipital lobe---------------->congrous hemianopia.

    **Listeria meningitis is typically associated with brain stem signs. CSF shows neutrophilic pleocytosis, low glucose and high protein.

    **Nystagmus is defind as involuntary oscillations of the eyes.
    THis may be
    1-Pendular: when the oscillations are equal in rate and amplitude.
    2-Jerking: when there are quick and slow phases(the quick phase is used to define the direction).
    pendular nystagmus is usually duee to loss of macular vision, but maybe seen in diffuse brain stem lesions.

    jerking nustagmus which is of constant direction regardless of the direction of gaze, suggests a labyrinthine or cerebellar lesion.

    Nystagmus which changes with the direction of gaze suggests a widspread central involvement of vestibular nuclei.

    Jerking nystagmus present only on lateral gaze, and who's fast component is in the direction of gaze, indicates a lesion of brain stem or cerebellum.

    Nystagmus confined to one eye suggests a peripheral lesion of the nerve or mucsle, or a lesion of the mediallongitudinal bundle.

    Nystagmus restricted to the abducting eye on lateral gaze(ataxic nystagmus) is due to a lesion of the medial longitudinal bundle between the ponds and midbrain as in MS.

    Nystagmus occuring on upward gaze with the fast component upwards( upbeat nystagmus) maybe due to a lesion in the mid-brain at the level of the superior colliculus.

    Downbeat nystagmus(fast phase downward) suggests a lesion in the lower part of the medulla. It's therefore, typical of the Arnold Chiari malformation.

    **Causes of absent ankle reflexes and extensor plantars:
    subacute combined degeneration of the cord
    syphilitic taboparesis
    friedreich's ataxia
    motor neuron disease

    **Bicuspid aortic valve is perhaps the most common form of congenital heart disease in adults(1-2% of population).

    **hyporeflexia is a common clinical sign in patients with hypercalceamia. Biphosphanates inhibit bone resorption and are the first line pharmacological treatment of hypercalceamia of malignancy.

    **Premature epiphysial closure is a classical finding of CAH.

    **Flecainide is the drug most likely to restore sinus rhythm in atrial fibrillation.

    **Lithium can produce Diabetes Insipidus and hypercalceamia.

    **Constrictive pericarditis produces an elevated JVP, with prominent x & y descent.Pulsus paradoxus occurs less frequently than in tamponade.

    **Streptococcus bovis is a normal commensal of the GI tract. However, S.bovis bactereamia and endocarditis has a strong association with GI malignancy.

    **Neisseria meningitidis( Gram negative diplococci)
    Streptocuccus pneumonia(gram positive diplococci)

    Rx:
    gram stain unavailable: cefotaxime+- ampicillin
    g +ve cocci: Cefotaxime +vancomycin( S.pneumonia)
    G +ve bacilli:Ampicillin +gentamicin.(listeria)
    G -ve cocci: Benzyl penicillin.(N.meningitidis)
    G -ve bacilli: Cefotaxime + gentamicin(heamophilus influenza)

    **Anaplastic carcinoma carries the worst prognosis in thyroid cancer followed by thyroid medullary carcinoma in MEN 2B.\

    **ANCA ab are of 2 types:

    1- C-ANCA which correlates with antiproteinase 3 antibodies--->most specific for wegener's granulomatosis.
    2- P-ANCA which correlates with anti myeloperoxidase ab. P-ANCA/MPO ab. are highly sensitive and specific for rapidly progressive glomerulonephritis and haemorrhagic alveolar capillaritis.

    AMA ab--------> PBC
    Anticentromere ab.--------> CREST/scleroderma syndrome
    ANA and anticardiolipin ab.----------->SLE.

    **Clozapine is associated with agranulocytosis in app.1-2% of patients

    **Acute pancreatitis with worse prognosis:
    Age>55
    WCC>16,000
    LDH>600
    AST>120
    Glu>10

    **Pendred's syndrome


    Pendred's syndrome is a rare autosomal recessive condition characterised by incomplete oxidation of trapped iodide prior to organification.

    It may be confirmed by a positive perchlorate discharge test.


    **Anti 21 hydroxylase ab. found in about 80% of cases of addison's disease.

    **SSRIs are a recognised cause of SIADH.

    **Astimulatory mutation of thr Gs protein alpha subunit has been noted in approx.30% of GH secreting pituitary tumours.

    **Carcinoid tumours of the foregut unlike tumours of the midgut are not associated with carcinoid syndrome but may secret CRF/ACTH resulting in ectopic cushing's syndrome.Other associated conditions include somatostatinoma, Zollinger -Ellison syndrome and Acromegaly.

    **The antiphospholipid syn. is one of the commoner causes of hypoadrenalism and may precipitate adrenal infarction and haemorrhage through adrenal vein thrombosis.

    **Osteopenia is defined as a T score of between -1 and -2.5 standard deviation below the bone mineral density of a young female.Osteoporosis is defined as <2.5 SD.

    **bcl-2 is an inhibitor of apoptosis.
    fas and caspases promote apoptosis but are nottumour supressor genes
    p53 is a tumour supressor gene that inhibits mitosis and promotes apoptosis.
    ras is oncogene.

    **Congenital adrenal hyperplasia is autosomal recessive disorder.

    **beta blockers are the mainstay of treatment in long QT interval. The most commonly used drugs are propranolol and nadolol.

    **pulmonary complications of reumatoid arthritis"
    Fibrosing alveolitis
    pleural effusions
    empyema
    cryptogenic organising pneumonia
    bronchiectasis
    pulmonary ndules

    **Fetal alcohol syn., Down's syn., and congenital rubella syn. are ass. with an ASD(Loud 2nd sound plus fixed splitting.

    **VIP
    Achlorhydria
    profuse diarrhea
    hypokalaemic acidosis
    hyperglycaemia

    **Cavitations on pulmonary x ray:
    squamous cell carcinoma
    abscess(staph. aureus, Klebsiella, and pseudomonas aeruginosa0
    lymphoma
    rheumatoid nodule
    pulmonary infarction
    wegener's granolumatosis

    **p-ANCA is present in approx. 70% with UC and less than 20% of Crohn.
    85% of untreated subjects with wegener's will have c-ANCA

    **prerenal failure:
    urinary Na<20
    urine osmolality> 500
    urine/plasma ratio>8and
    urine/plasma creatinine >40\

    Renal failure:
    Na>40
    osmolality urine<350
    U/P ratio<3
    U/P creat.<20

    **Vitamin D resistant rickets is x linked dominant.

    **infection is the commonest cause of death in multiple myeloma.

    **Antimicrosomal antibodies------>Hashimoto's thyroiditis

    **Behchet's disease is associated with HLA B5

    **Venous beading, loops and soft exudates(cotton wool spots) are ccharacteristic of preproliferative retinopathy.

    Microaneurysms, Hard exudates and Macular edema suggests background diabetic retinopathy

    New vessels suggests proliferative retinopathy.

    **Hexosaminidase A deficiency is ass. Tay-Sachs disease
    Sphingomyelinase deficiency ->Nieman-Pick disease
    Arylsulphatase-A Def. ass. with metachromic leucodystrophy
    Iduronidase def. ass. with Hurler's syn.
    B-glucosidase def.--->Gaucher's disease.

    **Methotrexate is a well known cause of acute pneumonitisand interstitial lung disease.

    **Clopidegrol prevent platelet aggregation through antagonism of the ADP receptor.

    **Patients with painful, isolated third nerve palsy with pupillary involvement are assumed to have posterior communicating artery aneurysm until proven otherwise.
  25. Guest

    Guest Guest

    no 7 is wrong
    gout is neg. bifringence
  26. re. gout

    absolutely right...apologise for the error - gout neg birefringence. thanks for spotting the error...
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