8/10/2019 Mcq s Notes 2014

1/33

Cardiology + Gastroenterology

Verapamilis used in the prophylaxis of prox. AF.

PFO: cause ofstroke in ayoung patient. Dx bybubble test echocardiography.

Pacemaker syndromein VVI (Heart block like): Retrogradeatrial activationfromventricular signal.

Co-arctationof aorta murmur: late systolic, loudest over thoracic spine.

Early PVE(up to 8 weeks) due to Staph epidermidis(commonest), Late PVEsameas native valve Staph viridans.

In-stent thrombosis occurs2 days post PCI, treated withabciximab + ASA andHeparin, and transfer to coronary angiography unit.

Confirmation ofburgadas syndrome: IV ajmaline (unmasks burgada) andEPS.

First line in chemical cardioversionofWPW: Flecanide, BBs may be used.

Cardiac arrest with ventricular arrhythmiaatlow core temperature: DC andchemical cardioversion isineffective, soCPR must be carried.

Indication ofFAB fragments indigoxin toxicity: 1. Severe arrhythmia 2.Hyperkalemia 3. Hemodynamic instability 4. Serum level >13 mg/dl.

After initial management of pulmonary edemawith oxygen, furosemide, and

morphine, GTN: 1. BP>100 mmHggive Nitroglycerininfusion, 2. BP 100-70 mmHg:with symptoms of shock give dopamine, without give dobutamine, 3. BP 250mmHg: is a termination cause of stress test. Diastolicpressure usually doesnt change or drop a little bit.

Tocolysis andsteroid usedin pregnancycan causepulmonary edema.

WPW sundrome: Type A: delta wave best seen in aVF and V4, and dominant R

wave in lead V1. Type B a negative delta wave in V1. Septic shock, first managed byfluids if not respondinginotropes.

Second provoked DVT is treated by6 month warfarin.

First linefor drug inducedlong QT syndrome: stoppingthe offending drug,correction of electrolytes, and starting IV Mg2+.

Patients withidiopathic pericarditis: NSAIDs is triedfirst, thencolchicine,steroids, and pericardiotomy.

Type A Aortic Dissection (involves ascending aorta):Treated surgically, whileType B that doesnt involve ascending aortais treatedmedically with BBs unlessthere iscomplication.

Development ofcardiogenic shock withVSD complicated MI: must besurgicallytreated.

Ventricular free wall rupture is more common thanVSD followingMI.

Contraindication of balloon mitral valvulotomy and indication of MVR: 1. Heavilycalcific valve. 2. Moderate to severe MR. 3. CAD that needs to be corrected. 4.Left atrial thrombus.

8/10/2019 Mcq s Notes 2014

2/33

Dysbetalipoproteinemia: cc bypalmar xanthoma, High TAGs, High Cholesterol,normal HDL and low LDL.

Myocarditis associated with cardiogenic shock management: 1. High flow oxygen 2.Hemodynamic suppot (PCWP>15 give inotropic (preferably IABP)+/-diuretics. IfPCWP < 15 mmHg give cautious IV fluid).3. Morphine (vasodilator and reduceanxiety).

Ebsteins anomalymay be associated with WPW.

One of indication of temporarypacemaker: Junctional rhythmwith QRS>160 ms. Complete heart blockas a reperfusion arrhythmiacarries the worstprognosis.

Intermediate risk of CAD: Stress Nuclear Imaging is recommended.

INR > 8 with no/minor bleedingStop warfarin and restart when INR8withhigh risk bleeding should be givenVitamin K 500ug IV (recommended over500mg oral). Severe bleeding---FFP.

TTP can happen rarely withClopidogrel and Ticlopidine.

Serial BNP helps todifferentiate betweenHF andCOPD exacerbation.

Flash pulmonary edema occurs in (from common to less):Myocardial ischemia,RAS, and AR.

BBs are the first line in idiopathicasymptomatic long QT syndrome.

Calcium channel blocker is thefirst line in treatment ofidiopathic pulmonaryhypertension.

Starting BBs in DCM can worsen symptoms of congestioninitially, but it shouldbecontinued andincrease the diuretics dose.

Pyoderma Gangrenosumcan occur around stomain patients with surgicalcorrected Crohns disease.

HF symptomsassociated with HOCMis treated with BBs, if failed or outflowpressure >50mmHg myomectomy.

Cardio-inhibitory CSH treated with:Dual chamber PM.

Risk ofin-stent restenosis of non-coated PCI in DM is 40-50%, decrease by 80%if drugillutant and dual antiplatelet is used.

Lutembacherssyndrome: ASD+MS(Congenital). NASH is a silent liver diseasediscovered accidently.

Celiac Dsis associated with disturbed liver enzymes.

Bacterial overgrowth is marked withincreased folate.

UTIsymptoms in a Diverticulitis patient due it peri-ureteric inflammation.

Chronic mesenteric occlusion: can cause malabsorption syndrome.

Hepatic Hydrothorax (peritoneal fluid is sucked through diaphragmatic openingsusually on the right) is treatedconservatively with low salt diet and diuretics iffailed, liver transplantation should be tried, if no facilityTIPS can be done.

Antibioticis started in traveller diarrheaonly if >3 days.

Purinesis preferred to 5-ASAcompounds in maintain remissionof crohns disease. Cholestasis of pregnancy: can be associated with increased PT.

Intermediate colitis (shares picture of UC and crohns disease)

HNPCC family: is screened forcolorectal cancer every 2 year starting fromearlytwenties.

8/10/2019 Mcq s Notes 2014

3/33

Fastingtransferrin level>55% is diagnostic forhemochromatosis.

Acute Liver rejectionoccurs 2 weekspost transplantation; first signis increasedALP and bilirubin. First line: IV methyl prednisolone.

Cardiac and liversymptoms of hemochromatosis improvewith treatment.

Antibodies associated with autoimmune hepatitis type I: ANA and Antismoothantibody, Type II (in children): AntiLKM, Type III: soluble liver kidney antigen.

IgAis raised in Alcoholicand chronic active hepatitis.

Terilpressinis contraindicatedin IHD;instead octerotideis used in esophagealbleeing varcies.

Coeliac Disease: is associated with T-cell lymphoma.

Radiation enteritis (chronic ischemia of intestine):occurs up to1.5 years afterradiation treatment of pelvic malignancy.Treatment rectal sucralfate,metronidazole and local anti-inflammatory.

Ascending cholangitis occurs inHIV is usually due toviral or fungal causes. FirststepMRCP.

Serum Albumin Ascetic fluid index: >1.1 portal hypertension (HF-high protein,Cirrhosis-- low protein, Budd chaiari-- high protein), 250 cells.

Pancreatic Pseudocyst is best diagnosed with CT scan.

Barretts oesopeghgus can lead to Adenocarcinoma in asymptomatic patients.

In Paracetamol overdose taken days ago,serum level could be normal orundetected.

Peripartum Cardiomyopathy can happen up to 5 monthafter delivery. Esophageal manometery confirms the dx of Achalasia, which consists of absent

peristalsis in the body of esophagus and increased tone of LES.

Lupus anticoagulant (increased PTT with normal PT)can cause Budd Chaiarisyndrome.

8/10/2019 Mcq s Notes 2014

4/33

Fundaparniux is anticoagulantused in patient with renal failure, because it is easilyremoved with dialysis.

RF for Long QT syndrome: 1.Female 2.hypokalemia 3.hypomagnesmia 4.CHF5.Digitalis toxicity 6.bradycardia 7.severe alkalosis.

Spironolactone decrease mortality when used in combination in patients with CHF.

Best antiplatelet after CVA(TIA or stroke) is Clopidogrel according the recentguidelines.

Procethic valve thrombosis management: UnstablepatientsFibrinolysis,Stablepatients---- Left sided valves surgery, right sided valves Fibrinolysis.

Dobutamine stress Echo in patients with low EF differentiate between true ASrequiring AVR and patients with pseudo AS due to low EF----in patients with true

AS the trans aortic gradient increase and the aortic area remain the same, while inpatients with pseudo AS the aortic area increases.

Treatment of peripartum cardiomyopathy: Low Na, Diuretics, afterload loweringagent typically hydralazine, heparin (due increase incidence of clotting) and digoxin.

Patients with high risk CVD (DM, PVD, CAD): should keep their LDL levelbelow 2mmol/l.

Osler Weber Rendu Syndrome (A.D): Also known as, Hereditary hemorrhagic

telangiectasia cc by multiple telangiectasiaon the skin and the mucus membranewith tendency to bleed and causing anemia, AV malformations.

Cirrhosis Types: 1. Macronodular: Chronic viral Hepatitis, 2. Micronodular:chronic alcoholism, However any type can be formed with both diseases.

Radiation enteritis: causes selective B12 deficiency, due to stricture and bacterialovergrowth.

PBC: Can be associated other autoimmune Ds like, Sjogren, CREST, and SLE.

Withdrwal of HRT is necessary inHepatocellular adenoma, and Budd chaiarisyndrome.

Acute fatty liver of pregnancy: causes low albumin level.

Fulminant Wilsons Ds: increased serum copper andhemolysis.

Most common causes of Chronic Pancreatitis: Alcohol, CF, Idiopathic. Marker of the Neuroendocrinetumors: Serum Chromogranin Aexcept insulinoma.

Varigate Porphyria: N, V, abdominal pain, increased porphyria in urine, stool, andplasma.

Porphyria Acute intermittent

porphyria

Variegate

porphyria

Hereditary

coproporphyria

Clinical pic N, V, Abd pain,

photosensitivity,

neuropsychiatric

symptoms

Same Same

Urine Porphyria Elevated Elevated Elevated

8/10/2019 Mcq s Notes 2014

5/33

Fecal Porphyria Normal Elevated Elevated

Plasma Porphyria Normal Marked Elevated Normal

FMF: cc by paroxysm of Feverand serosal inflammation (peritoneal and plueral).Constipationwith fever and becomes diarrheawith resolution, amyloidosis.

Disease Achalasia Scleroderma Nutcracker

LES Manometery Increased Tone Decreased Normal

Body peristalsis Absent Absent Increased

Increased gastrin andincreased Basal acid in stomach: ZES and H.Pylori infection(Can be diff by secretin test, which inhibits gastrin in H. pylori infection)

Increased gastrinand Decreased Basal acid: PPIs, Gastric cancer andpernicious anemia.

Whipples Dsiease:Attacksintestine (malabsorption), Heart (pericarditis), Joints(Arthritis and arthralgia), CNS (Ocular and Cerebellar) and cause Hyperpigmentation.

Left Petrous Temporal region lesion: Affects all branches of trigeminalnerve andabducent.

Hamartomatus Polyps in: Puetz Jeghers Ds, Codwens syndrome, Familialjuvenile polyposis, NF1, and MEN type IIb.

Iron Deficiency anemia without obvious cause investigations: Upper and Lowerendoscopy, urine analysis and celiac Ds markers.

Proven benefittreatment in acute pancreatitis: Oxygen, IV fluidsand enteralfeeding.

Chest pain + Troponin> 0.03suggests MI: Do Coronary Angiography.

Autoimmune Hepatitis: CC by increased Liver enzymes and Increased ALP. Obese + HTN + Signs of CHF: Start ACEIs or ARBs.

Q waves in the Anterolateral and inferior leads in: HCM.

Treatment of VSD caused by MI: Medications: Inotropes, Surgical: Intra-aorticballoon, formal surgery and percutaneous closure.

Treatment of High altitude pulmonary Odema: Oxygen, if not available calciumchannel blockers.

BBs is the 1stchoice in prophylaxis against paroxysmalAF.

BP goal in HTN+DM and HTN+RF is 130/80 mmHg.

JLS1 and 2: Long QT+ Deafness

LQT1:Attack during or after exercise

LQT2:Attack during exercise or auditory stimuli

LQT3:Attack at night during sleep.

LQT4:paroxysmal AF.

Pancreatic Psuedocyst:Complicate Acute pancreatitis after few weeks cause:Abdominal Pain, Tender mass, persistent elevated enzymes, low grade fever.

8/10/2019 Mcq s Notes 2014

6/33

Prophoryia can be precipitated by Alcohol or drugs like OCP.

Hemochromatosis: Confirmed by Genetic testing or liver biopsy.

Thumb printing: Sign of Ischemic Colitis.

Hepatic Steatosis: Is caused by 1. Alcohol 2. Obesity 3. DM.

Pellagra Ds Triad: Dermatitis, Diarrhea and Dementia.

Zieves Ds:Alcoholsim+Hemolysis+Hyperlipidemia+Abdominal pain+increasedBilirubin.

In UC endoscopic rectal biopsy: if associated with dysplasia, it means there iscarcinoma elsewhere in the body.

Secretin Test in Chronic Pancreatitis: Volume>2ml, and HCO3

8/10/2019 Mcq s Notes 2014

7/33

Aspergillus (stained with H&E)causes 5 lung diseases: 1. Asthma (type I HS), 2.ABPA (type III HS) 3. Aspergilloma 4. Invasive Aspergillosis 5. Externsicallergic alveolitis.

INH causes Optic neuritis.

Deviation of the trachea is seen with tension pneumothorax, but not spontaneouspneumothorax.

Pulmonary hemorrhage caused by wegner granulomatosis is associated by

increased DLCO. Lymphangitis carcinomatosis: gives Restrictive pattern.

Pulmonary alveolar proteiniosis: Causes lung infiltration (crazy paving) withPAS +ve granules made from surfactant protein.

Prednisolone is added to the tx regimen of PCP if the oxygen 80%predicted, moderate 80-

50%, severe 50-30% andvery severe

8/10/2019 Mcq s Notes 2014

8/33

Respiratory failure type II in COPDpatients: Conscious: BiPAP, or Doxapram(#Hypertension), Unconscious: Intubate and ventilate.

RFfor Staphylococcal pneumonia: Post influenza and IV drug user.

Chrug Strauss triad: Asthma, Eosinophilia, and Systemic vasculitis.

Idiopathic PF: 1. Common in middle age male smokers 2. Linked to Wood andMetal dust 3. Associated with positive ANA and RF in 50%.

Mixedobstructive/restrictive pattern + Polyurea and Polydepsia: Histocytosis X

PCP and Methotrexate induced pneumonitis: Causes Fever, SOB andDesaturation during exercise.

Respiratory intervention in patients with GBS is done when the FVC around 1liter.

In patients with high risk perioperative mortality for lung cancer: Combined chemoand radiotherapy increase the chance of survival.

Treatment of ABPA: Oral steroids +/- Antifungal.

In the reversible obstruction COPDpatients: Use of steroid inhaler + B2 agonistdecrease COPD exacerbation.

Rustycolored sputum in Strept pneumonia.

Chemoprophylaxis of HIV patients exposed to TB: INH + Pyridoxinetwice weekly

for 9 months or Rifampin for 4 months. Hepatopulmonary syndrome:A-V shunting, Pleural effusion, Hx of liver disease,

Hypoxia and Platyapnea (relief on lying flat), Tx: liver transplation.

FVC is the most important investigation to monitor GBS.

Contraindication of pneumonectomy in lung cancer is:FEV1

8/10/2019 Mcq s Notes 2014

9/33

Alveolar microlithiasis (AR): CC by calcified microlithesdeposition in thealveoli, PFTs restrictive, CXR lungs shows microcalcifications, Fatal eventuallyfrom respiratory failure.

Factors increase perioperative mortality in COPD:1. Increased PCO2 onoxygen 2. FEV1

8/10/2019 Mcq s Notes 2014

10/33

GravisEye Disease can occur with normal TFTs.

Wolmans Ds: Hypoadernalsism, HSM, steatorrhea.

Wolframs Ds: DM, DI, Optic atrophy and deafness.

PGSI: Key Mucocutneous candidiasis. PGS II (commonest type): keyDM.

Prolactin level > 3000is diagnostic for microprolactinoma, and > 6000formacroprolactinoma.

Euthyroid sicksyndrome: Low T3, T4 and normal TSH. Osteomalacia: IncreasedALP, decreasedPO4, DecreasedCa2.

Familial Heterogeneous Hypercholesterolemia: CC by Cholesterol >7.5,Achilles tendon xanthomas, increased risk of CAD.

GH deficiency is diagnosed with insulin tolerance test(GH 800after DAAVP injection.

Pseudohypoparathyroidism:short stature, squint, low ca (due to PTHresistance), high po4, associated hypothyroidism(resistance to TSH).

Initial medication for treatment ofgestational diabetes after failing life style

modificationisMetformin theninsulin if failed. Initial Tx ofThyrotoxicosis isCarbimazole.

Weight loss inPCOS leads to:decrease insulin resistance, and increaseSHBG whichdecrease freeAndrogens.

Glucgnoma: DM + NME skin rash.

Liddles syndrome: Low renin+ Hypokalemia+ Hypertensive+ metabolicalkalosis. Tx: Amiloride.

Carcinoid syndrome:can produce GnRHin addition to serotonin.

Bratters and Gitelmans syndrome: Elevated renin and Aldosterone+Hypokalemia+ Normotensive.

Indication of surgery in Hyperparathyroidism: Calcium> 3mmol,increased RFTs, Hypercalciurea, marked increase bone reabsorption,nephrocalcinosis and increased bone stones.

Tumor produces phosphaturic substances: Prostatic carcinoma, CLL,and MM.

Necrobiosis lipoidica diabeticorum: Assoicated with uncontrolled DM,Erythematous Plaques on shins and wrists. Tx: Steroids (Topical andinjectable steroids).

Throtoxicosis during pregnancyTx: Initially start with PTU, if noimprovement increase the dose, then change the drug, and if failedsurgery.

Initial Test for Pagets Dsis: Skeletal Survey. Tx: Bisphosphanate.

Hypertriglyceridemia: CC by eruptive xanthomas.

Pregnancy and old age can decrease TSH.

RF for Thyroid malignancy:1. Female Sex 2. Endemic goiter 3.Hashimotos 4. FAP 5. Radioactive Iodine 6. Hx of thyroid adenoma 7.Radiotherapy.

8/10/2019 Mcq s Notes 2014

11/33

Metformin and Sulfonylureais contraindicated in moderate RF.

DM causes increased TGsand Decrease HDL.

Klinfilters and Mumps orchitis after puberty can cause 1ry testicular failure.

Supraseller Calcified cyst= Craniopharyngeoma.

Amiodarone induced hyperthyroditis AIH: 1. Type I(Iodine content,Increase blood flow with Doppler, Normal RAI uptake, normal IL6, Tx:

Antithyroid+potassium Percholorate) 2. Type II(Destructive thyroiditis,

decreased BF with Doppler, decreased RAI uptake, increased IL6 Tx:Antithyroid+steroids).

Postpartum thyroiditis (3-7 months after labor): the same clinical data ashashimotos Ds.Treatment: Low dose thyroxin, withdrawn after 6month to measure the success of treatment.

In insulinomafasting test: the cutoff value after 15 hrs fasting of glucose2.5 mmoland 5 mu/l insulin.

In patients with combined hypothyroidism and hypoadernalisim, dontgive thyroxin before treating hypoadernalisim because it might precipitateaddisonian crisis.

Renal Artery Stenosis: Causes increased Renin and Aldosterone.

High doseMetformin causesBile acid malabsorption and diarrhea. Phenoxybenzamine is used 3 days before pheochromocytoma surgery to

ensure alpha block.

Suppressed TSHand increased Free T4is normally seen in pregnancy.

LMW Heparinis used in the management of DKAto prevent venousthrombosis.

Treatment ofthyrotoxic adenoma: Radioiodine or Subtotalthyroidectomy. In pregnancy: PTU.

Pentagastrin stimulation test: Used forMedullary thyroid carcinoma.

Metforminis the initial step in treatment of GDM.

DM associated withchronic pancreatitis is treated withinsulin.

Essential Thrombocytosis is associated with pseudo-hyperkalemiawhen the sample auto hemolyse.

Treatment of osteoporosis associated Klinfelters is Testosterone.

Peroglide and Cabergolineis associated with pericarditis.

Alfacalcidiol is used in tx of 2ry hyperparathyroidism.

Cinacalcetis used in patient with hyperparathyroidismand ESRD.

P. Neuropathy is treated with Doxletine, Amitryipaline or carbamazepine.

Absent olfactory pulp in Kallmanssyndrome.

Nonfunctioning pituitary adenoma: Treated surgically.

Lung cancers and Adrenals: Paraneoplastic=Ectopic ACTH=Cushing,

Adrenal Metastasis=Hypoadrenalisim. DM who wishes to exercise heavilyare advised to use basal insulin

bolusinstead of mixed insulin.

8/10/2019 Mcq s Notes 2014

12/33

Management of postural hypotension of DM neuropathy:1. StopAntihypertensive (VDs and Diuretics) 2. Elastic stocking 3.Fludrocortisone.

Prolactinoma: PL should be>5000.

Diabetic Amylotrophy (usu. involves sacral plexuses):Require control withinsulin.

In Synthacyn test: Cortisone should rise>550 after 30mins.

Initial treatment in MODY3is: SUs. Conns Ds: Due toAldosterone secreting adenoma (low renin).

Treatment of myxedema coma: IV hydrocortisone(first if therehypoadernalism or status unkown, Slow rewarmingand Thyroxin.

Treatment of gravis ophthalmology: 1. Steroids (tried first) 2. Surgicaldecompression 3. Orbital radiotherapy.

McCune Albrightsyndrome: Increased risk of osteosarcoma.

8/10/2019 Mcq s Notes 2014

13/33

Nephrology:

Commonest renal pathology occurs with RTis Mesangioproliferative GN.

PCKD causes RFwith increased Hb level(increased erythropoietin

secretion). Cholesterol emboli: Low C3, eosinophilia, Increased ESR and Urine

protein.

Oral Ironin not well absorbed in patients with CRF, thus should be given inIV form.

Tight control of glucosein DM reduces microvascularcomplication: 1.Neuropathy60% 2. 50% Retinopathy3. Nephropathyand proteinuria by 30-40%.

Pulmonary hemorrhage seen in Wegner Granulomatosis andGoodpasture.

Sinusaffection + Renalaffection= WG.

Psuedohyponatremia in Nephroticsyndrome due to high serum lipid.

CKDpatients should have k < 5.5mg/dl if undergoing surgery.

Chaurg strauss: Can cause renal affection andnephritic syndrome.

Calciphylaxis(deposition of calcium in arteries leads to necrosis): A lifethreating seen in ESRDon dialysis

Types of grafts: 1. Autograft: from, to same person 2. Isograft: fromidentical genetic person. 3. Allograft:from similar genetic person 4. Xenograft:from different species.

Othrotopic: Graft in same anatomical place. Heterotopic: Differentanatomical place.

Triad of renal cell carcinoma: Costovertebral pain, Hematuria, and Mass. Types of kidney stones: 1. Ca oxalate(Most common): Radio opaque from

hypercalcemia. 2. Cystiene stone: Radio opaque from cystinuria. 3. Urate stone:Radiolucent from hyperuracemia. 4. Oxalate stone: Radio opaque from IBDs andethyl glycol ingestion. 5. Struvite stone: Radio opaque from infection especiallyprotues, pseudomonas and kelibsiela.

Aluminumcauses osteopeniaand osteomalacia.

Bratter syndrome: CC by Low Na, K, and Cl.

In central DI:Urine osmolality must rise by 50%.

Gitelmans: Assocaited with Hypomagnesaemiaand Hypocalciuria.

Scleroderma renal crisis: HTN+Microangiopathic Hemolysis, Treated with

ACEIsor ARBs. ATNtreatment supportive.

Flash Pulmonary odema: Seen in RAS, and Fibromuscular dysplasia.

ADPCKD: its recommended to screen patients after 20 yrs. old in high riskgroup.

8/10/2019 Mcq s Notes 2014

14/33

Normal urine: Can contain red cells, granular and hyaline casts.

IgA Nephropathy: IgA is only elevated in 50%.

Dapsone: Causes hemolytic anemia.

Xanthgranulomatous Pyelonephritis: Occurs in DM, Difficult to distinguishfrom RCC (Weight loss, fever, loin pain), treatment is nephrectomy.

Fibromuscular Dysplasiacan become symptomatic with HTNinpregnancy.

Calciphylaxis: Occurs in patients with CKD, Ulcerswith calcified bloodvessels.

Anemia with CKD:if ferritin

8/10/2019 Mcq s Notes 2014

15/33

Incision of flexor retinaculae incarpal tunnel syndrome toreliefcompression.

Corticosteroids and other immunosuppressiveisNOT needed in treatmentof CIN.

Treatment ofHIV associated Nephropathy: HAARVT+ ACEIs.

Diabetic Nephropathy: Chance of 45%renal function worsening duringpregnancy.

Membranous Nephropathy Treatment: Control ofBP andedema bydiuretics and Clexan.

Thyroid Function Test: Should always be checked in elderly presentingwith behavioral changes.

Serum osmolarity: 2(Na+K)+ Urea+ Glucose.

8/10/2019 Mcq s Notes 2014

16/33

Hematology

Acanthocytosis:cc by spur bodiesin peripheral blood, hemolytic anemia, fatmal-absorptionsymptoms, movement and CNS problemsesp. orolingual.

Phases of the clinical trial: Phase 0(pharmacodynamics and pharmacokinetics),

Phase I(safety of the drug often done with phase II), Phase II(efficacy andsafety), Phase III(comparison with another drug), Phase IV(post marketing).

In patients with lab finding of DICwithout obvious symptoms: Treatmentisdirected only for the cause (no blood product is given).

CML treatment in young: if there is no matched sibling for stem cell transfusion,used Imatinib.

Rapid reversal of warfarin is ideally donebyprothrombin concentrate.

INR > 8 without symptoms: Give Oral or IV vitamin K.

Hydroxyurea decrease the incidence ofacute chest syndromes with HbSS

Cold Agglutinins (IgM): P. blood shows agglutination in cold temp., Coombs is+ve, usually not paroxysmal.

Paroxysmal cold hemoglobinuria (Antibody attaches to RBCs in cold temp.):Causes severe hemolysis, back pain and rigors. Coombs is negative.

Warfarin induced Skin necrosis: Due to fast decline in vitamin K dependentprotein C (1-2 days).

Heparin induced skin necrosis:Antibody mediated (10-14 days).

Alpha Thalassemia minor: Silent will havenormal hemoglobin electrophoresis. Delayed transfusionreactions (5-10 days): picture of autoimmune hemolytic

anemia.

Myelofibrosis: Causes increased WBCsand +/- increased Platelets.

Leucoerthyroblastic changes in blood (increase band cells, promyelocytes andmyelocytes)in BM infiltration and severe hemolysis.

Only treatCLL when patient issymptomatic with B symptoms.

Antiphospholipid syndrome: CC by venous and arterial thromboembolism,miscarriage in 1sttrimester, levidoreticularis, and libmansac endocarditis.Tx:Warfarin

Leukemia prognosis depends oncytogenetic.

Acquired haemophillia:Antifactor VIII. Tx: Steroids and/orimmunosuppressors.

Treatment of ITP: High dose steroids.

Prothrombin Complex: Contain vitamin K dependent factors, used in severebleeding due to warfarin overdose.

Cryoprecipitate: Contain factor 8 and fibrinogen. FFP: Contain low dosesof coagulation factors.

HIT: Type I: in 1stfew days after starting heparin, plts mild decrease. Type II:

after week to 2 weeks, plts < 50000, venous thromboembolism.

8/10/2019 Mcq s Notes 2014

17/33

Irradiated blood: is needed in patients with cellular immunodeficiency (Post stemcell transplant, cong. Immunodeficiency).

Fludarabine: can be complicated withPCP infection, thusco-trimoxazoleprophylaxis is recommended.

Acquired Hemophilia: Common in elderly and pregnancy(Associated withautoimmune disease due to antibodies towards factor 8). Treatment activatedfactor 8.

Isotope white cells scan: used inFe deficiency anemia wheninflammatorydisorder is suspected.

FFP: Is rich in fibrinogen likecryoprecipitate.

Myelofibrosis: Old age, pancytopenia, splenomegaly, increased BM cellularity.

Commonest organism to infectneutropenic patient is: gram +ve (stapepidermidis).

Wiskott Aldrich:Reduced Igs, eczema, and thrombocytopenia.

Stains in hematology: 1. TARP+ve: Hairy cell leukemia. 2. Sudan Black andmyeloperoxidase+ve: AML 3. TDT+ve: ALL 4. LAP High: PRV, andMyelofibrosis, Low LAP: CML.

Difference betweenAlpha thalassemia minor andBeta thalassemia minor is

HbA2 (decreased in A TM, Increased in B TM). Spleenis considered LN groupin staging lymphoma.

Veno-oclusive disease of liver usually occurs2 weeks afterBMT.

Waldenstromscauses: Lymphoplasmacytoidlymphoma, LN enlargement andBM infiltration.

8/10/2019 Mcq s Notes 2014

18/33

Rheumatology

In shrimer test for Sjogren syndrome: The wetting of the filter paper should be atleast 4 mm after 5 mins.

First linein treatment of 1ry Osteoporosisis Bisphosphonates. The risk of osteosarcomain Pagets diseaseis < 1%. Proteus infectionis linked to development of RA.

Difference invertebral affection betweenAS and Psoriatic arthritis issymmetryandnon-symmetry, respectively.

First sign of SLE reactivationactivity is C4 level falling.

Relapsing polychondoritis: RecurrentFever, Weight loss, Cartilageinflammation (picture according to site), Tx:Symptomatic + Steroids.

Treatment of felty syndrome: pulsed steroids or cyclophosphamide, if failedsplenectomy.

Poor response with HBV vaccineand Tetanusin IgA deficiency.

Factor V leidenincrease the risk of venous thromboembolism only if patient usesOCP.

There isincreased risk ofhemolytic anemia withRA.

Treatment of Pagetsdisease: Bisphosphonate or Colchicine.

ANA +ve in 60-90%of SS, while other antibodies specific for SSis +ve in 50%only.

ANA+ve in 20%of Stills disease.

Nail fold capillarscopydifferentiate between 1ry and 2ry Raynauds.

Joints symptoms + Purpuric rash + positive RF= Cryogolubinemiaor Sjogrens.

Drug that can be used for RAduring pregnancy: Sulfadiazine, Azathioprine(notin breast feeding)

Charcot Joint (increase osteoclastic activity): Severejoint destructionwithminimal symptoms. (DM, Syphilis, Leprosy, syringomyelia). DDx: indiumradiolabelled WBCs. Treatment:Immobilization+/-Bisphosphonate.

Neuropsychiatric Lupus: Lupus manifestation + Neurological and Psychiatricsymptoms.

Polymyocyitiscan cause bulbar muscle weakness.

Lead poisoning: causes aldosterone resistance(RTA type 4).

Thyroxinneed in pregnancyis increased by 25%.

Adult onset Stills Disease: Fever, Weight loss, Arthralgia/Arthritis, Anemia,HSM+ve and Lymphadenopathy.

Anti TNF must be stopped 2-4 wksbefore major surgery(Because it interfere

with wound healing). C1 estrase inhibitor deficiency: recurrent angioedema due to trauma, causes

abdominal pain and swelling without rash or fever. TreatmentC1 inhibitor.

T- score of -1.5 is a cutoff valueto start osteoporosistreatment in steroid userpatients.

8/10/2019 Mcq s Notes 2014

19/33

P-ANCA: can bepositive withMM.

Feltys syndrome: Occurs in longstanding RF seropositive patients cc by: 1. RFsigns. 2. Splenomegaly 3. Leucopenia 4. Lymphadenopathy 5. Skin ulcers. 5. ANA+Ve in 90%.

Pseudogout: NOT associated with Bakers Cyst.

Electromyography and nerve conduction: Used for confirmation of CarpalTunnel Syndromebefore surgery.

Drug induced Lupus: ANA +ve, RF +ve, Antihistone +ve, and Normal Comp.level.

Osteomalacia can cause muscle pain and weakness.

Discoid Lupus: Form oflupus withscarring photosensitive skin manifestationsis the main symptoms.

Lupus pnerio: Dusky skin lesion onnose insarciodosis.

The most commonLung manifestation inLupus isPleural effusion andpleuritis.

SimvastatinandCaptopril can causedrug induced Lupus.

Anti dsDNA is confirmatory for Lupusandcorrelate fordisease activity.

Treatment ofmethotrexate overdose: Ca folinate, Hydration and

Alkalanization of urine. Proprionibactirum Acne: Common gram +ve organismfound in hip prosthesis

during time of revision (Asymptomatic).

Rubricase: Used in the treatment and preventionof goutassociated withtumor-lysis syndrome.

8/10/2019 Mcq s Notes 2014

20/33

Neurology, Psychiatry and ophthalmology: There is a variantin Huntington choreathat expressed in youth(Early), with

associated Parkinsons symptoms. Steroidsare proven to favor outcome of facial palsy.

MND (LMNL+UMLN+bulbar affection):can affectold age.

Basilar artery territory lesion causes: cerebellar, ocular and speechdysfunction.

IIH is a diagnosis of exclusion (cerebral venous thrombosis must be excluded).

New variant CJD: affects young age and EEG is variable unlike sporadic CJD.

IV IGs and plasmapharesis can reverse the symptoms ofMG quickly.

CIDP: increased protein in CSF, lymphocytic pleocytosis, MRI enhancement.

Normal pressure hydrocephalus triad: starts withgait disturbance, cognitivedeterioration thenurinary incontinence.

Lumbar puncture and nerve conduction studies can be normalearly in GBS. Mononeuritis multiplex: improves over6 month period withoccupational

therapy and physiotherapy.

Holmes Aides eye: dilated sluggish reactive pupil, with decreased reflexes ofbody.

Friedreich ataxia:cerebellar symptoms, pes cavus, heart hypertrophy, areflexiaand spastic paralysis.

Botulismcan cause false +vetensilon test.

Refsums disease (accumulation of phytanic acid):peripheral neuropathy,deafness, anosmia, cerebellar symptoms, blindness and pes cavus.

Difference between paroxysmal hemicrania (treatment:Indomethacin)andcluster headache: PH in female vs. male in CH, up to 50 attacksvs. 1-4,shorter duration20 mins vs. hour. They sharethe same autonomicandunilateralcriteria.

8/10/2019 Mcq s Notes 2014

21/33

Sudden deterioration of MG (myasthenic crisis), due to illness or spontaneousoccuring, Treatment: Elective ventilation, stoppage of anticholinergic,Plasmapharesis or IV Igs.

Giant cell arteritis:Associated with anterior chamber ischemicopticneuropathy(painless loss of vision).

Anticoagulantis given in vertebral artery dissection (use MRA to confirm) toprevent distal thromboembolism.

Thyrotoxicosisis associated with periodic paralysis(Hypokalemia). Pituitary Apoplexy(hemorrhage inside the gland): causes bitemporal

hemianopia, hypopituitarism.

Occulomastactory Myorrhythmia: in whipples (Nystagmus, upward gaze palsyand jaw claudication).

Rubeosis iridis:complication of diabetes and HTN,can lead to blindness.Treatment pan retina photocoagulation(prognosis is poor).

Radiation Plexopathy:occurs after radiotherapy>6000 cGy, usually in upperbrachial plexus, painless and associated with lymphodema.

Deja vu, epigastric sensation, followed by loss of consciousness and oralautomatisms: Temporal lobeepilepsy (complex partial seizure, Hx of febrile

seizures). Locked in syndrome: occlusion of basilar artery, quardripelgia, only blinking

and upward gaze is present.

Sub-acute sclerosing pan-encephalitis: chronic measlesinfection (measlesearly in life followed by 6-8 years of no symptoms, then mental and motordeterioration).

EEG inherpetic encephalitis shows front-temporal wave slowing, withintermittent sharp wave complexes.

Annual Fundoscopyis offered to people with DM1 and DM2 with normal retina.

Causes of isolated 6thnerve palsy: MG, Sarcoidosis, Thyrotoxicosis, MS, and

GCA (old Age).

MS: Worsening of symptoms a hot bath. Temporal lobe lesion causes: Contralateral superiorhomonymous

quardrantanopia, while Parietal lobe causes contralateral inferiorhomonymousquardrantanopia.

Wilson Disease: Causes extrapyramidal signs, emotional liability, personalitychanges anddepression.

Causes ofAcute confusional state (Fluctuating course, worse at night):Systemic infections, drugs, metabolic, hypoxia, hypercapnia, vascular, andtrauma.

Carotid artery dissection: causelower cranial nerve palsies (VII, Hypoglossal).

Organism associated withGBS: Campylobacter, Chlamydia, Hep B, EBV, HIV,HZV, CMV andMycoplasma.

First line ofIdiopathic Parkinsons disease treatment: 75 yrs old--Levedopa.

Toxoplasma Chorioretinitis : Unilateral, mild ocular pain, blurred vision (hazy),White yellow lesions in fundoscopy.

8/10/2019 Mcq s Notes 2014

22/33

REM sleep behavior disorder: Early sign ofParkinsons disease.

Serotonin syndrome (caused by SSRIs or MAOs):Hyperthermia, Musclerigidity, circulatory instability and agitation.

Feredirech Ataxia: Upper and lower MN lesions, Sensory affection, Atrophy ofsmall muscles of hand, Ataxia, and nystagmus.

GBScauses Nerve demyelination(Slowconduction and Blockedat severalintervals).

Ependyoma: Tumor arises near filum terminal in spinal cordcauses chronicback pain +/- Saiatica and increased T2 signal on MRI.

Pontine lesions are associated withconvergent squint (due to lateral rectuspalsy).

Lymphoctosis+Low CSF glucose+Hight Protein= T.B meningitis.

Clopidogrel is used in2ry prevention ofTIA according to the current guidelines.

PSP: Parkinsonian + Dementia + Ophthalmopelgia.

Miller Fisher (Variant of GBS): Ophthalmoplegia + Areflexia + Ataxia + muscleweakness.

Metabolic causes of convulsion: Hypo/Hyperglycemia, Hypo/hypernatremia,Hypocalcaemia, Hypomagnesaemia, uremia and hypoxia.

Cerebral venous sinus thrombosis: Headache, Focal motor and sensory sign,Papilledema. RF: Increased coagulopathy. DDx: MRV. Tx: Heparinfollowed bywarfarin.

Corticobasal Degenration: (Parkinsons plus syndrome)Parkinsons feature +Aphasia + Alien limb phenomena +/- dystonia, myoclonus.

Glomus Jagulare Tumor(vascular tumor) arises near jugular foramen (compressVII, IX, X, XIand causes conductive hearing loss.

Tropical spastic paresis (HLTV-1 associated myelopathy): UMNL in legs that iscontagious.

Inclusion Body myositis (most common acquired myopathy):Affects quadricepsandlong flexors. CPK increased but not much.

Huntington Disease: CC bybehavioral disturbance withsuicide ideation andabnormal eye movement (slow saccades).

Brachial neuritis(Neuroalgic Amylotrophy): Tender, pain with movement,weakness in shoulder griddle musclefollowing surgery or infection, with sensoryloss over deltoidmuscle.

Narcolepsy: is characterized by tetradExcessive daytime sleeping,Cataplexy, sleep paralysis, sleep hallucinations. DDx by sleep latency test Tx:Modafinil.

Vertebral artery dissection:can be associated with Lateral orMedialmedullarysyndrome.

Subacute combined degeneration:can occur in folatedeficiency!

Subthalamic nucleus damage due stroke or inflammation:causes contralateralhemibalithmus. Treated with dopamine antagonist(helps with movementdisorder).

The rashof dermatomyositisis photosensitive.

8/10/2019 Mcq s Notes 2014

23/33

Bickerstaff's encephalitis: Ataxia, Opthalmoplegia and hyperreflexia(vs MillerFisher, Ataxia, opthalmoplegia and areflexia). DDx: Anti JQb1is often positive asMFS.

Sarcoidosis can cause basal meningitiswith lower cranial nerve palsiesas acomplication.

Limbic encephalitis (Antibodies to potassium channel):Memory impairment,disturbed conscious +/- seizures and psychiatric disturbances.

L4: (Knee Reflex), Sensation--Anteromedial of calf region, Knee Extension. L5: Sensation--Anterolateral, Knee Flexion.

S1: (Ankle reflex), Sensation--Sole of foot, Foot eversion.

Kearn Sayre Syndrome (mitochondrial disorder): Loves eye(Opthalmoplegia(upward gaze), Ptosis, Retinitis pigmentosa. Cardiac symptoms. Cerebellarsymptoms.

Carotid angiography: is the gold standard in diagnosis of Carotid Dissection,although non invasive technique can be used e.g. Carotid duplex.

PSP: Upwardand Downwardgaze can be affected before horizontal one.

You can drive the car after6 month inunprovoked seizure (after beingassessed), 3 years in seizureduring sleep and night.

Phenytoin toxicity: Cerebellar symptoms. Carotid artery dissection: Posterior Neck pain may be the only presenting

symptom, Cranial nerve palsies, and stroke. Treatment: Anticoagulant.

Vertebral artery dissection: Severe neck andoccipital pain, symptom ofcerebellar affection.

Antidyslipidemic should be used in the2ry prevention ofCVA, even if thecholesterol normal.

Painful 3rdnerve palsy: Due to vascular lesion (posterior communicating arteryaneurysm, DM (ischemia), and coarticoaortic fistula.

Cerebello-pontine angle space occupying lesions:Affect cranial nerve 5, 6, 7,and 8.

Benign Coital Headache (variant of migraine):Acute severeheadache happenswith or after orgasm (due to autonomic dysregulation). DD. Subarachnoidhemorrhage.

Propranalol canexacerbate MG.

Interferon B is used inMS to reducerelapses. Steroids are used duringacuteattacks.

Neurological affection inLyme disease: Mono-neuritis multiplex, cranial nerves4, 5, 6, 7, and 8.

Sciatic nerve palsy (L4:S3): Supply all muscles of the lower leg.

Multifocal neuropathy (Autoimmune Disease): LMNL affectingparticular limb+No sensory affection,multiple conductionblock in NCS.

Wernicke Encephalopathy Triad: Ataxia, opthalmoplegia and delirium, alsothere may be hypoglycemia, Hyothermia and hypotension. Can occur in anymalnorshiment (e.g. Hyperemesis gravidarum).

Carotid Artery Dissection: Intracranial typeheadache + Stroke, Extra-cranialtype: Neck swelling + 9, 10, 11 cranial palsies + Horners.

8/10/2019 Mcq s Notes 2014

24/33

Vertebral Artery Dissection: Occipital pain and affection ofposteriorcirculation (cerebellum) or Affection ofanterior spinal artery.

Intra-cecal Lymphoma:Associated withincreased oligoconal bands anddecreased glucose inCSF.

Binswanger Disease: (small vessel arteriopathy)caused byhypertension andleads toencephalopathy.

Chronic Headache syndrome (overuse of pain killers): starts with tension or

migrane headache. Treatment:Discontinue pain killers, amitrypitaline. CADASIL: (small vessel arteriopathy) subcortical infarctsand

leucoenchephalopathy. BP is normal.

Anterior inferior cerebellar artery (lateral lower pontine infarction):Affection ofcranial nerve 8, 7, conjugate eye movement and Horner syndrome.

Juvenile Myoclonic epilepsy: Hx ofconvulsions at morning + absent seizures,4-6 Hz spikes in EEG. Treatment:Valproate (carbamazepine andphenobarbitone should be avoided (worsen seizures)).

Burning limbsafterexercise, hot weather or febrile illness inFabrys Disease.

Stiff person syndrome (Autoimmune, paraneoplastic): Recurrent stiffnessinproximal lower limb musclesand paraspinal muscles(absent during sleep).

Critical illness myopathy: Proximal myopathy in critically ill personsreceivingmuscle relaxants and steroids.

Delusional Depression is best treated byECT.

Lock in syndrome: infarction ofproximal and middle basilar artery segments(Brain stem),bulbar and UMNLs. Distal lesions are CC by deterioration inconsciousness.

Contraindication tothrombolysis in stroke: recent head trauma,BP>180mmHg, active bleeding.

Inpatients suffers fromstroke, should be transferred to stroke unit for betterresult.

Lewy body dementia (visual hallucinations and Parkinsonism with fluctuating

dementia): treated byAnticholinesterase. Indications of carotid endarterectomy: the more therisk factors, the more isthe

benefit.

MG: Anti acetylcholine receptor positive in90%, while the remaining10% canbe diagnosed withanti specific muscle kinase.

Weber syndrome--Eye (Midbrain lesion in cerebral peduncle):3rdnerve palsy,

contralateral hemiplegia (flaccid paralysis + up going planter reflex).

Gretsmanns syndrome (dominant parietal lobe lesion):Finger agnosia, left toright disorientation, dysgraphia and achalcula.

Marchiafava Bignami (corpous collusom degeneration): chronic Alcohol use.

MG: isexacerbated with pregnancy, and usuallyassociated with otherautoimmune diseases.

Brain tumors: is generally not chemosensitive. Whole brain radiationis usedfor multiple brain metastasis, while sterotactic radiotherapyis more localizedfor specific lesions.

8/10/2019 Mcq s Notes 2014

25/33

Juvenile myoclonic epilepsy (early onset): Myoclonic jerks (worse in themorning) + Generalized tonic clonic + absence seizures.First line: Valproate.

ASA is used for1ry prevention of stroke, while it is switched toclopidogrel in2ryprevention.

CADASIL: (Mutation NOTCH-3 gene)Autosomal dominant, migraine followedbysubcortical infarcts and then dementia.

Vision constriction is seen in patients usingvigabatrin.

Electromyography: can be used to confirmmyotonic dystrophy (waxing andwaning potential Dive bomber), instead of biopsy.

Alcoholic Neuropathy:Early numbness,then paresthesia(especially at night),progressing to severe pain. Also have features of motor loss.

Infectious Disease and GUM

Endometritis: Fever, foul vaginal discharge, abdominal pain, Treat: Clindamycin

+ gentamycin. Loaisis:Angioedema + Parathesia + leukocytosis + Eosinophilia.

PML:Presents with Visual, cognitive, behavioral, motor, and masseson HeadCT in immunocomporomized.

Herpes Zoster Opthalmicus: Can lead toserious eye complications if nottreated.

Acute Histoplasma infection: can presents with glandular feverand erythemanodsum.

The most common organism causesmeningitis after shunt operation forhydrocephalus is staph epidermides.

Salmon Colored rash in: Typhoid Fever.

Tick Typhus (R.Conori): Causesblack eschar + Lymphyadenopathy. Tx:Doxycycline.

HIVcan be associated with TTPand should be excludedon clinical suspicion.

Tropical Sprue: Diarrhea withpartial villous atrophy.

Patient withmeningitis from placedshunt is investigatedwithMRI.

Dengue Fever:Associatedwithfever > 40 C andhemorrhagic symptoms.

Esinophilic folliculitis: Most commonpapular purpuric skin lesion inHIV (usuCD4

8/10/2019 Mcq s Notes 2014

26/33

Yersenia enterocolitica: Causes polyarthritis, Uveitis, apthus ulcer, GN,Appendicitis, Lymphadenitis and erythema nodosum.

Leshmania Tropica Minor: Causes Cutaenous leshmaniasis (Scaly skinulceration).

Aciclovir if started early within 72 hoursof HZV infection, can lead to shorteningand less complicated disease.

Chronic Brucellosis: Loves liver, bone, CNS and BM. Treated: Doxycyclinewith

streptomycin or rifampicin. Bradycardia inTyphoid andBrucellosis.

Acute HIV causes: Leucopenia with relative lymphocytosis and thrombocytopenia.

Meningitisassociated with fracture skull base: IV linezolidshould be given(covers staph aureus and epidermidis)

Alopecia and Apthous ulceris a common association with 2ry syphilis.

Difference between oral hairy leukoplakia and oral candidiasisis that patchesare dislodged easilyin candidiasis.

Parvoviruscauses anemia in HIV personsTreated with IV Igs.

WhenPO2 6 attacksper month, Aciclovirgiven for 3 months. Typhoid Fever: FAHM, diarrhea or constipation, Cough, Salmon colored rash.

(D.D. Malaria). Treated with Ceftriaxone(or Amoxicillin, Ciprofloxacin (highresistance)).

Slapped Cheek Disease (Caused by Parvovirus): Causes Fetal AnemiaandHydrops fetalis. Treatment IV IGs.

Dengue Feveris either a hemorrhagicfever, rash, FAHM, early lymphocytosis,later lymphopenia, thrombocytopenia and anemia. Or a simple (remitting)fever, sweating, lymphadenopathy, maculopapular rash. Treatment:Supportive.

Allow 48 hrsafter giving antimalarial to see an effect on parasitaemia (>10%

exchange transfusion). Chancriod (H.ducrei) is treated by macrolides or quinolones.

Ciprofloxacin+ Loperamide: reducethe severity of traveler diarrhea.

Malaria prophylaxisshould be continued7 days after return usingAtovaquone/proguanil or 4 weeks using mefloquine alone.

Drugs used in the prophylaxis of meningitis: Rifampicin, Ciprofloxacin (Firstline, Single dose), and ceftriaxone (Single dose).

Yaws (trepenoma): HyperKeratotic skin lesion looks like wart(TPHA is positive),Treatment: Penicillin.

Strongyoides (Far East area): Anemia, Pulmonary infiltration(can bechronic),, GI symptoms (can be chronic), eosinophilia, rash (may be linear)Treatment:Ivermectin or Albendazole.

Zidovudine:Associated withfat distribution andHyperglycemia.

Nucleoside reverse TI:Associated withcardiomyopathy.

Pinta (trepenoma): Hyper-pigmented skin lesions.

Cryptosporidum: Diarrhea in immunocompromised. Tx:Nitzoxanide.

8/10/2019 Mcq s Notes 2014

27/33

VZV Igs: given within3-7 days post exposure.

Nucleic acid amplification testing (NAAT): is used to detectgonococcus andchlamydia.

Histoplasmosis (common with exposure to bats and birds): Treated with AmphoBfollowed by Itraconazole.

Filariasis: Treated withAlbendazole (single),Ivermectin, andDEC.

Chagas Disease: Treated bynifurtimox orbenzidazole.

Churg Strauss: can causeCNS vasculitis. Vaccines can be used inpregnancy: TT, Diptheria, and Hep B.

Dermatology: Acanthosis nigrigans: Associated with hypothyroidism.

CCBs: Associated with intermittent facial flushing.

Necrobiosis Lioidica (in DM):Lesions onfront of shins (shiny, Atrophic,brown-red or slightly yellow and margins could be erythematous or violet).

Phototoxic reaction: erythema and blisters in a patient using drug(e.g.

ciprofloxacin) after exposure tosunlight. Morphoea (Localized scleroderma):Thickening in the skin following byhyper or

hypopigmentation. Treated withtopical steroids.

Vitamin D analogueis used as a second lineafter topical steroids in psoriasis.

Granuloma annulare (immunocompromised): Dermal nodules fused together toform rough ring shape. Treated with intra-lesion steroids.

T.B salpingitis: Can occurwithout pulmonary signs.

Drug Hypersensitivity syndrome (3-6 weeks after starting the drug):Fever,Facial edema, popular and pastular rash and lymphadenopathy.

Ulcers in BehcetDisease are Apthsustype.

Lupus Vulgaris: Scarring skin lesions due to T.B infection. Treated with Anti T.B. Cutaneous leshmaniasis: Flu like illness thenSkin lesions.

Treatment fortenia capitis is given forat least 3 months.

Lichen Planus: Heals with hypopigmentation indark skinned persons.

Pyoderma Gangernosum:Can occur at the site of surgery.

8/10/2019 Mcq s Notes 2014

28/33

Herpetic Whitlow (HSV affecting fingers):causeherpetic rash, cellulitis,lymphadenitis andlymphedema.

Stevens-Johnson syndrome: Erythematous papules andblisters affectingbody andmouth, conjunctive andgenitalia.

Seborrhoeic Keratoses (senile warts):in old age, stuck on appearance,usuallyon theback.

People showingdermatitis herptiforms rash forcoeliac disease may be

asymptomatic. Tenia cruris: Sharply demarcated rash (symmetrical or Asymmetrical) that

spares the scrotum if it involves genitalia(D.D. candida: involves scrotum).

HPV(kissing warts): Skin colorednodules.

Oral leukoplakia: White lesions at the side of the mouththat cant be dislodgedcaused bysmoking and alcohol.

Dermatitis Artifacta: Self inflected linear or geographical lesionsthat appearovernight.

Toxic Epidermal Necrolysisis a Cytotoxic T cells and apoptosis.

Rosacea (photosensitive): erythema with telangiectasia, papules and pastulesmimicking acnebut no comedones, swelling and distortion of nose. Treatment

antibiotics. Retention Keratosis(complication from varicose veins): Treatment surgical

debridment.

Oral acycloviris useful onlyif given in the 1st48hrs after HZVinfection.

Yellow nail syndrome: inbronchiectasis, COPD, pleural effusion, nephroticsyndrome and penicillamine use.

Erythema Multiforme: occurs inmycoplasma, HSV, sulphonamides andpenicillins.

Lichen Planus: occurs at the site of a previousscar.

Erythema gyratum repens: Wood grainrash appearance, associated withmalignancy.

Isotretinoin side effects: Teratogenic, depression, impairment of night vision,alopecia, and worsening of acne.

Mohs surgeryis done in BCCfor cosmeticconsideration.

Erythroderma (90% of the body affected): inEczema, andpsoriasis.

Clinical Pharmacology and toxicology:

Phenytoin (can cause increased liver enzyme) and Carbamazpine: causescerebellar toxicity.

8/10/2019 Mcq s Notes 2014

29/33

Indication ofliver transplantation inParacetamol toxicity: 1. PH 3 mmol after fluid resuscitation. 2. Three of the followingCr>300,PT>100 (INR>6.5) and GIII or IVEncephalopathy.

PTU is recommendedearly in pregnancy, whilecarbimazole isrecommendedlater.

The rash ofpsoriasis isincreased byBBs, lithium, NSAIDs andAntimalarial.

Long term antiepileptics are notrequired in treatment of acute alcoholwithdrawal, instead IV lorazepamcan be used for prophylaxis.

Parlidoxime: Antidote for organophosphate poisoning(muscarinic andnicotinic symptoms).

SSRIs and SNRIs: Enhance the effect of anticoagulant.

Zivudine: cause red cell aplasiaand megalobastosis.

Activated charcoalcan be given up to12 hoursafter salicylatestoxication.

Treatment ofdigoxin related VT: 1stline IV phenytoin, 2ndline lidocaine.

Antidote ofcyanide: Dicobalt edetate, sodium nitrate orsodiumthiosulphate.

Senna andDantron Laxative: causemelanosis coli. HIT type I: Platelet count isobserved without stopping LMWH.

Calcium Folinate (leucoverin):used in the overdose of methotrexate.

Treatment of Non functioningadrenal adenocarcinoma:Mitotane.

Oral Diazepam reducing dose: used initiallyin treatment of BDZswithdrawal.

Dystonic reaction caused byMetoclopramide, stemetil, is treated byprocyclidine.

Treatment ofneuroleptic malignant syndrome:Bromocriptine.

Pyridoxine: can cause non-ironmicrocytic anemia.

Penicillamine: causeMG.

Antidote forbarbiturates: Sodium bicarbonate.

Safe antibiotic to be used inG6PD deficiency: Augmentin.

Arsenic poisoning(glass industry/rodenticide): Diarrhea, Horizontal naillines (mees), and abdominal pain.

Indinavir: Renal stones andhyperbilirubinemia.

Clozapine: Associated with 7 fold increase in risk of DM andweight gain.

Fibrates: Leads to formation ofgallstones.

St. Johns wart: Enzyme inducer.

Clozapine: causesneutropenia (CBC monitoring required).

Alkalinzation of urine in treatment ofsalicylates overdose is done byIV

NaHCO3 (NOT WITH forced alkalnization of urine). Mefenamic Acid (Ponstan) overdose presents with seizures.

Adminstration of NACin treatment of paracetamol overdose: can causeanaphlactoid reactioninitially (Tx: stop the infusion temporarily, if there issevere respiratory reaction: give adrenaline).

8/10/2019 Mcq s Notes 2014

30/33

Multiple dose charcoal can be given with overdose of: Carbamazipine,Digioxin, Dapsone, Theophylline, phenobarbital, salicylates andQunine.

Paracetamol overdose isasymptomatic in the first hoursafter ingestion.

Hydroxyurea: decreases pain and hospital admission of SSHb.

Drug induced psuedolymphoma (skin):T-cell infiltration due to usage ofantiepileptic, antihistaminic, antiarrhythmic, and some antibiotics.

VT associated withTCA toxicity: is treated withNAHCO3 if failedLidocaine.

Treatment ofATN associated withparacetamol toxicity ishemodialysis.

Treatment ofParkinsons relatedDepression: Fluoxetine, Psychosis:Resipridone.

Calcium Alginate: used in thedressingofbed sore withnecrotic tissue.

Ketoconazole and Fluconazole are enzymeinhibitors.

Promethazine: is used as a first line in nausea withpregnancy.

Antimalarial exacerbatespsoriasis.

Ethylene Glycol toxicity: Multiorgan failure.

Using antibiotic oncedailyis safer than using multiple dosesin

nephrotoxic antibiotics. Alpha methyldopa and Labetalolis safeantihypertensive during

pregnancy.

Early toxicity ofAspirin overdose isRespiratory Alkalosis, and thenlateit is metabolic acidosis.

Latent T.B (+ve blood test without symptoms and signs of T.B):Rifampicin+ INH for 3 months.

Sodium Nitroprossiude: degrades intocyanide when exposed tosunlight.

Atenolol causesIUGR in pregnant, while labetalol and nifidipine aresafe.

Vancomycin is associated withdizziness and tinnitus.

Adrenaline IM dose inanaphylaxis: 0.3-0.5 ml of 1:1000

Amantadine isalternative for(interferon + Ribavirin) in treatment ofhepatitis C in patients suffer fromadverse effects.

Early cyanide poisoning causeHTN+bradycardia, vomiting, abdominalpain, later hypotension and coma.

Augmentin and ciprofloxacin: Associatedwithpic of obstructive jaundice.Erythromycin increases liver enzymes only.

Antibiotic safe in pregnancy:Amoxicillin, Ampicillin,Clindamycin,Erythromycin,Penicillin.

In salicylates poisoning: if the patient is hypokalemic, correction of hypokalemiais done first, before giving NaHCO3 (at PH

8/10/2019 Mcq s Notes 2014

31/33

Cranberry Juice (enzyme inhibitor)interacts withwarfarin (Increase INR). Grapefruit juice (enzyme inhibitor)interacts withsimvastatin and ciclosporin. Sodium Valproate (can cause PCOS like syndrome): 1

stline inabsence seizure

Cyclizine or Domperidone is preferred over metoclopramide orprochlorperazine as antiemetic inyoung people for risk ofdystonic reactions.

Indication of antivenom: systemic affection (Hypotension, tachycardia, highWBCs, severe limb swelling.

Contraindications of infliximab: 1. Active infections 2.MS 3.Pregnancy 4.Breast feeding 5. HF 6.Active T.B

Volatile substance abuse is associated withtype 1 distal RTA. Fullers earth is given postparaquat ingestion, if not found and within 4 hrsof

ingestion activated charcoalmay be given. Contraindications ofsodium nitroprossiude: Vitamin B12 deficiency, Lebers

optic atrophy and severe liver disease. Porphyria is madeworse bycarbamazepine. Colchicine: causesmyoneuropathy. Posterior leucoencephalopathy (looks like hypertensive encephalopathy):

caused by immunosuppressive drugs likecyclosporine, Tacrolimus,cyclophosphamide, and methotrexate.

Isoniazid overdose: causesrenal failure and metabolic acidosis. Lead poisoning:Associated withproximal RTA. Hyperkeratosis of skin of palm and soles, with transverse line on nails:Arsenic

poisoning. Theophylline toxicity: Agitation, polyuria, Hypotension, GI upset, metabolic

acidosis andhypokalemia. Dot signin sylvian fissure: sign of brain infarction (MCA). Treatment

thrombolysis.

8/10/2019 Mcq s Notes 2014

32/33

Oncology and palliative medicine:

Hypercalcemiaof malignancy: Treated with IV fluids and bisphosphonate.

Cord compression: Dx.best withMRI. Treatment:IV steroids +/-surgery orradiation.

Liver transplantation can be done in liver tumors up to 3 masses < 3cm.

Carcinoid syndrome can causepellagra due toconsumption oftryptophan.

1stline inSVC syndrome (obstruction with lung tumor):IV steroids.

Tumor marker ofseminoma: B-HCG.

Bony metastases: associated withhot spots inbone scan (may be osteogenicor osteolytic).

Corrected calcium= serum calcium + (40-serum Albumin) X0.027. Patient with pretreatment of myeloprolifirative disorders high LDH, is at risk of

tumor lysis syndrome.

Dermatomyocytosis is associated withesophageal cancer.

Poor prognosis ofEwings sarcoma in: male, >12 years old, anemia, increasedLDH, poor response to chemotherapy.

There is an association ofpapillary carcinoma of thyroid and FAB.

Contraindication of surgical removal of lung cancer: 1. SVC affection 2. Nearmain bronchus 3. Malignant pleural effusion 4. FEV < 2 L.

Mesothelioma:increasedrisk withradiation exposure.

Prognosis ofbreast cancer depends a lot onnodal affection.

Most commonsolitary nodule in non-smokers is2ry fromRCC.

Usage ofsomatostatin analogue shrink tumor before surgery ofpituitary.

Small cell carcinoma is almost always disseminatedby the time of diagnosis.Treatment chemotherapy+ Radiotherapy.

VHL: Hemangioblastoma affecting retina, cerebellum, brain and abdomen.

8/10/2019 Mcq s Notes 2014

33/33

Hairy cell leukemia causesmonocytopenia.

Pupil of Horner syndromecaused by pancosts syndromedoesnt dilatewithatropine.

Successful treatment of non-Hodgkinlymphoma increase risk of leukemia.

Upper andmiddle esophageal cancer needsbronchoscopy to excludetrachealinvolvement.

Pheochromocytomais associated with 2ry polycythaemia.

Hodgkin Lymphomaoccurs in relatively young age,while non-Hodgkinoccursin old age.

Paraneoplastic syndrome of RCC secretes: EPO, PTrP, and ADH.

Testicular choriocarcinoma: can besmall size andnot detected with clinicalexam,associated with markedlyhigh bHCG, normal AFP and CEA, andearlymetastasis to lung.