Mrcp part 2 preparation

Discussion in 'MRCP Forum' started by komal, Oct 13, 2012.

  1. komal

    komal Guest

    Motor neuron disease (MND):
    • A systemic (i.e. bilateral) neurological disease of unknown cause affecting the MOTOR SYSTEM only (UMN or LMN or both).
    • Rarely presents before 40 years.
    • A degenerative disease of a gradual onset and progressive course.
    • 5 clinical types (NO ataxia or sensory signs/symptoms):
    1. 1ry lateral sclerosis (UMN affection in spinal cord).
    2. Pseudo-bulbar palsy (UMN affection in brain stem or cerebral hemisphere) = bulbar symptoms (e.g. dysarthria) + quadriplegia + signs of UMNL in ULs and LLs + exaggerated palatal and pharyngeal reflexes + appearance of jaw reflex if the lesion is above pons + NO tongue wasting or fasciculations.
    3. Progressive muscular atrophy (LMN affection in AHCs of lower C or L region in spinal cord) = weakness with signs of LMNL e.g. wasting, hypotonia and fasciculations + affects distal ms before proximal ms + THE BEST PROGNOSIS.
    4. PROGRESSIVE BULBAR PALSY (TRUE BULBAR PALSY) (LMN affection in the cranial nerve motor nuclei) = bulbar symptoms + NO quadriplegia + lost palatal and pharyngeal reflexes + absent jaw reflex + tongue is wasted and shows fasciculations + THE WORST PROGNOSIS.
    5. Amyotrophic lateral sclerosis (ALS) (THE MOST COMMON TYPE = 50% of patients) (combined UMN & LMN affection) = UMNL signs (e.g.  m tone) + LMNL signs (e.g. absent reflexes) in ULs (TONIC ATROPHY) & UMNL signs in LLs + in familial cases the gene responsible lies on chromosome 21 and codes for superoxide dismutase.
  2. komal

    komal Guest

    Hepatitis B markers (serology):
     HBs Ag:
    1. Appears 6 weeks after infection (THE FIRST MARKER TO APPEAR DURING ACUTE HEPATITIS B INFECTION).
    2. Disappears after 3 months.
    3. Persistence > 6 months = CARRIER state (asymptomatic) or CHRONIC state (infective) (symptomatic).
    4. Normally implies ACUTE disease (present for 1-6 months).
     Anti-HBs Abs = appear after 3 months and persist + indicate recovery or IMMUNITY (exposure or IMMUNISATION) + NEGATIVE IN CHRONIC DISEASE.
     Anti-HBc Abs (implies previous OR current infection):
    3. IgM = chronic active B hepatitis + appears during acute or recent hepatitis B infection + present for 6 months.
    4. IgG = carrier or old (previous) infection (i.e. IgG anti-HBc Abs PERSIST).
  3. komal

    komal Guest

    prostate CA --
    -localized
    1-watchful waiting,radiotherapy n radical prostatectomy...fit pt refereed for surgery less fit for radiotherapy.
    metastatic or advanced---LHRH with or without antiandrogens

    metastatic bone pain--irradiation to local site
  4. komal

    komal Guest

    Narcolepsy:
    • Caused by the loss of the hypothalamic neuropeptide orexin (orexins are released from synaptic terminals during wakefulness and  the activity of brain regions associated with wa-kefulness).
    • Has strong association with the HLA Ags DR2 (HLA DR2) (99%) and DQ1 (HLA DQ1).
    • Features (clinical features):
     Excessive daytime somnolence = a cardinal feature + symptoms are impro-ved after a brief nap.
     Hypnagogic hallucinations = vivid and often frightening hallucinations just after falling asleep or just before waking + effectively a mixture of REM sleep and wa-kefulness.
     Cataplexy = defined as sudden episodes of bilateral muscle weakness leading to partial or complete collapse + usually triggered by strong emotions (e.g. anger, laugh-ter or intense excitement) + weakness is present for 1-2 minutes + consciousness is NOT impaired + almost 2/3 of patients with narcolepsy go on to develop cataplexy.
     Sleep paralysis = a complete inability to move 1 or 2 minutes after waking + often accompanied by hypnagogic hallucinations.
    • Diagnosis is clinical but 2 investigations are performed to exclude other causes of hypersom-nolence:
     Overnight polysomnogram (overnight polysomnography) = may be normal in patients with narcolepsy but may demonstrate spontaneous waken-ings and REM sleep within 20 minutes of falling asleep + normal patients do NOT go into REM sleep for 80-100 minutes after the onset of sleep since orexin inhibits REM sleep.
     The following day Multiple sleep latency test is performed = the patient is allowed to nap every 2 hours on 4 or 5 occasions + patients with narcolepsy fall asleep within 5 minutes whereas most normal patients take 10-15 minutes to fall asleep + the naps in narcolepsy patients induce REM sleep and the presence of sleep-onset REM in 2 or more naps is highly suggestive of narcolepsy.
    • Treatment:
     Modafinil (a non-amphetamine wake-inducing drug) (an analeptic drug) (a mood-brightening and memory-enhancing psychostimulant).
     The alternative is Methylphenidate (an amphetamine drug) (a psychostimulant drug).
  5. komal

    komal Guest

    Primary sclerosing cholangitis (PSC):
     A biliary disease of unknown aetiology.
     A chronic progressive inflammatory disorder of medium and small-sized bile ducts.
     The main pathological feature = inflammation, fibrosis and immunological destruction of intra-hepatic & extra-hepatic bile ducts.
     90% of PSC is associated with IBD, particularly UC, and hence the importance of THE INTERMITTENT DIARRHOEA.
     Features (clinical picture) = asymptomatic at presentation + cholestasis (fatigue and pruritus are common complaints as with the other cholestatic disorders) + advanced liver disease + approximately 1/5 of cases complain of right upper quadrant pain.
     Investigations = ERCP (to confirm the diagnosis) (the standard diagnostic tool, showing multiple strictures within biliary ducts giving a "beaded" appearance) + positive ANCA + liver biopsy (has a limited role, showing fibrous, obliterative cholangitis often described as "onion skin").
     Complications = complications of chronic cholestasis = steatorrhoea + fat-soluble vitamin malabsorption + large biliary strictures + cholangitis + cholangiocarcinoma (10%) +  risk of colorectal cancer (colonic carcinoma).
     Treatment:
     NO effective pharmacological agents that greatly retard the progression of the dis-order.
     Symptomatic ttt  cholestyramine (bile salt sequestrant to  pruritus) + fat-soluble vitamins (parenterally) (necessary owing to steatorrhoea).
     Biliary stenting  improve biochemistry & symptoms.
     The definitive ttt  hepatic transplantation.
  6. komal

    komal Guest

    Indication of FFP--acute DIC,TTP
    cryoprecipitate--DIC,HYPOFIBRINOGENEMIA
    Irradiated Blood product ---HODGKIN,STEM CELL TRANSPLANT,PT on Purine Analogue ( FLUDRABINE) OR IMMUNOCOMPROMISED
  7. guest2011

    guest2011 Moderator

    hodgkin lymphoma
    stage 1-- single lymph node involv
    2-- 2 or more lymph node on same side of diaphrgam
    3- involvement of lymph node on both side of diaphragm
    4-metastasis
    Dr Rahmat likes this.
  8. Dr Rahmat

    Dr Rahmat New Member

    Please write some tropic like these .

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