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Pacemaker syndrome in VVI (Heart block like): Retrograde atrial activation from ventricular
signal.
Early PVE (up to 8 weeks) due to Staph epidermidis (commonest), Late PVE same as native valve
Staph viridans.
In-stent thrombosis occurs 2 days post PCI, treated with abciximab + ASA and Heparin,
and transfer to coronary angiography unit.
Cardiac arrest with ventricular arrhythmia at low core temperature: DC and chemical
cardioversion is ineffective, so CPR must be carried.
After initial management of pulmonary edema with oxygen, furosemide, and morphine, GTN: 1.
BP>100 mmHg give Nitroglycerin infusion, 2. BP 100-70 mmHg: with symptoms of shock give
dopamine, without give dobutamine, 3. BP <70 mmHg give norepinephrine.
Indication of AVR in AR: 1. EF <55% 2. Severe LVEDV >80ml even if the patient
asymptomatic 3. Symptomatic.
HOPE study suggested ACEIs decrease morbidity and mortality for patient with high risk
cardiovascular events with normal LVEF.
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.
First line for drug induced long QT syndrome: stopping the offending drug, correction of
electrolytes, and starting IV Mg2+.
Patients with idiopathic pericarditis: NSAIDs is tried first, then colchicine, steroids, and
pericardiotomy.
Type A Aortic Dissection (involves ascending aorta): Treated surgically, while Type B that
doesnt involve ascending aorta is treated medically with BBs unless there is complication.
Development of cardiogenic shock with VSD complicated MI: must be surgically treated.
Ventricular free wall rupture is more common than VSD following MI.
Contraindication of balloon mitral valvulotomy and indication of MVR: 1. Heavily calcific valve.
2. Moderate to severe MR. 3. CAD that needs to be corrected. 4. Left atrial thrombus.
INR > 8 with no/minor bleedingStop warfarin and restart when INR<5, INR>8 with high
risk bleeding should be given Vitamin K 500ug IV (recommended over 500mg oral). Severe
bleeding---FFP.
Flash pulmonary edema occurs in (from common to less): Myocardial ischemia, RAS, and AR.
Calcium channel blocker is the first line in treatment of idiopathic pulmonary hypertension.
Starting BBs in DCM can worsen symptoms of congestion initially, but it should be continued and
increase the diuretics dose.
Pyoderma Gangrenosum can occur around stoma in patients with surgical corrected Crohns
disease.
HF symptoms associated with HOCM is treated with BBs, if failed or outflow pressure >50mmHg
myomectomy.
Hepatic Hydrothorax (peritoneal fluid is sucked through diaphragmatic openings usually on the
right) is treated conservatively with low salt diet and diuretics if failed, liver transplantation
should be tried, if no facility TIPS can be done.
HNPCC family: is screened for colorectal cancer every 2 year starting from early twenties.
Acute Liver rejection occurs 2 weeks post transplantation; first sign is increased ALP and
bilirubin. First line: IV methyl prednisolone.
Antibodies associated with autoimmune hepatitis type I: ANA and Antismooth antibody, Type
II (in children): AntiLKM, Type III: soluble liver kidney antigen.
Radiation enteritis (chronic ischemia of intestine): occurs up to 1.5 years after radiation
treatment of pelvic malignancy. Treatment rectal sucralfate, metronidazole and local antiinflammatory.
Ascending cholangitis occurs in HIV is usually due to viral or fungal causes. First step MRCP.
Serum Albumin Ascetic fluid index: >1.1 portal hypertension (HF-high protein, Cirrhosis-- low
protein, Budd chaiari-- high protein), <1.1 no portal hypertension (T.B, Nephrotic, Malignancy).
Mid-arm ms circumflex & skin fold thickness is useful tool in detecting nutritional status.
Antibiotic
H2 blocker
PPIs.
In Paracetamol overdose taken days ago, serum level could be normal or undetected.
Lupus anticoagulant (increased PTT with normal PT) can cause Budd Chaiari syndrome.
Fundaparniux is anticoagulant used in patient with renal failure, because it is easily removed with
dialysis.
Best antiplatelet after CVA (TIA or stroke) is Clopidogrel according the recent guidelines.
Procethic valve thrombosis management: Unstable patientsFibrinolysis, Stable patients---Left sided valves surgery, right sided valves Fibrinolysis.
Dobutamine stress Echo in patients with low EF differentiate between true AS requiring 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 in patients with pseudo AS the aortic area
increases.
Treatment of peripartum cardiomyopathy: Low Na, Diuretics, afterload lowering agent typically
hydralazine, heparin (due increase incidence of clotting) and digoxin.
Patients with high risk CVD (DM, PVD, CAD): should keep their LDL level below 2 mmol/l.
Osler Weber Rendu Syndrome (A.D): Also known as, Hereditary hemorrhagic telangiectasia
cc by multiple telangiectasia on the skin and the mucus membrane with tendency to bleed and
causing anemia, AV malformations.
Radiation enteritis: causes selective B12 deficiency, due to stricture and bacterial overgrowth.
PBC: Can be associated other autoimmune Ds like, Sjogren, CREST, and SLE.
Varigate Porphyria: N, V, abdominal pain, increased porphyria in urine, stool, and plasma.
Porphyria
Acute intermittent
Variegate porphyria
porphyria
Clinical pic
N, V, Abd pain,
photosensitivity,
neuropsychiatric
Hereditary
coproporphyria
Same
Same
symptoms
Urine Porphyria
Elevated
Elevated
Elevated
Fecal Porphyria
Normal
Elevated
Elevated
Plasma Porphyria
Normal
Marked Elevated
Normal
FMF: cc by paroxysm of Fever and serosal inflammation (peritoneal and plueral). Constipation with
fever and becomes diarrhea with resolution, amyloidosis.
Disease
Achalasia
Scleroderma
Nutcracker
LES Manometery
Increased Tone
Decreased
Normal
Body peristalsis
Absent
Absent
Increased
Increased gastrin and increased Basal acid in stomach: ZES and H.Pylori infection
(Can be diff by secretin test, which inhibits gastrin in H. pylori infection)
Increased gastrin and Decreased Basal acid: PPIs, Gastric cancer and pernicious anemia.
Whipples Dsiease: Attacks intestine (malabsorption), Heart (pericarditis), Joints (Arthritis and
arthralgia), CNS (Ocular and Cerebellar) and cause Hyperpigmentation.
Left Petrous Temporal region lesion: Affects all branches of trigeminal nerve and abducent.
Hamartomatus Polyps in: Puetz Jeghers Ds, Codwens syndrome, Familial juvenile polyposis, NF1,
and MEN type IIb.
Iron Deficiency anemia without obvious cause investigations: Upper and Lower endoscopy, urine
analysis and celiac Ds markers.
Proven benefit treatment in acute pancreatitis: Oxygen, IV fluids and enteral feeding.
Chest pain + Troponin> 0.03 suggests 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-aortic balloon, formal
surgery and percutaneous closure .
Treatment of High altitude pulmonary Odema: Oxygen, if not available calcium channel blockers.
BBs is the 1st choice in prophylaxis against paroxysmal AF.
Respiratory:
High dose combination (Fluticasone+Long acting B2 agonist) used in severe COPD leads to
slow deterioration in FEV1.
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. Externsic allergic alveolitis.
Deviation of the trachea is seen with tension pneumothorax, but not spontaneous
pneumothorax.
Pulmonary alveolar proteiniosis: Causes lung infiltration (crazy paving) with PAS +ve granules
made from surfactant protein.
TRALI (common in multiparous women): caused by anti HLA or Anti neutrophil due to
blood transfusion, with a picture similar to pulmonary edema. Treatment supportive.
Bronchoscopy is the tool of choice in large lung mass, because using other tool will risk
causing pneumothorax.
Mild OSA: Weight loss and/or intraoral device. Moderate to severe OSA with day time
sleeplessness: CPAP.
The initial investigation in partial upper airway obstruction is Flow Volume loop.
COHb prognostic level: <30% headache and dizziness, 30-60% tachycardia, tachypnea,
fits,>60% Cardiorespiratory failure and death.
CO poisoning: Patient is conscious fitting mask with 100% oxygen, Comatose intubate and
ventilate.
X-ray in patients with CF: Sinus XR Shows panopacification of the sinuses, CXR shows
hyperinflation and peribronchial thickening (Bronchiectasis).
Idiopathic PF: 1. Common in middle age male smokers 2. Linked to Wood and Metal dust 3.
Associated with positive ANA and RF in 50%.
PCP and Methotrexate induced pneumonitis: Causes Fever, SOB and Desaturation during
exercise.
Respiratory intervention in patients with GBS is done when the FVC around 1 liter.
In patients with high risk perioperative mortality for lung cancer: Combined chemo and
radiotherapy increase the chance of survival.
In the reversible obstruction COPD patients: Use of steroid inhaler + B2 agonist decrease
COPD exacerbation.
Chemoprophylaxis of HIV patients exposed to TB: INH + Pyridoxine twice 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.
Poor response to broad spectrum antibiotic in the treatment of pneumonia: is due to either
Atypical or fungal pneumonia.
Life threatening Asthma either presents by: 1.PO2 <8 2.PEFR <33% (200L) 3.Spo2 92%
4.PCO2 normal (4.6-6) or increased 5.silent chest 6.cyanosis 7.poor respiratory effort
8.arrhythmia 9.poor conscious.
Eaton Lambert: Antibodies against calcium channels the NMJ (Anti calcium channel
antibody).
Management of PE: Heparization, if the BP is boarder line with signs of right sided HF give
volume expanders. Use thrombolytic if the patient is collapsed or failure of increase of BP
after 30 mins from giving the volume expanders.
Factors increase perioperative mortality in COPD: 1. Increased PCO2 on oxygen 2. FEV1 <0.8
3.Obesity 4.poor performance and cardiac status.
Features raise the possibility of malignancy of lung nodule: 1.Old age 2. Smoking history
3.enhanced contrast on CT 4. Speckled mass with distortion of the near vessels.
Nuclear pleomorphisim with absent mitosis in lung mass: Diagnose carcinoid tumor.
Management of bronchial carcinoid: if solitary lung mass, surgical removal, if not Ocreotide
should be tried.
Endocrine:
Initial tests for polydipsia and polyuria are UA, Serum Ca and Serum Glucose.
Prolactin level > 3000 is diagnostic for microprolactinoma, and > 6000 for
macroprolactinoma.
Partial DI: CC by urine osmolarity of 300-800 and failure to rise >800 after
DAAVP injection.
Initial medication for treatment of gestational diabetes after failing life style
modification is Metformin then insulin if failed.
Weight loss in PCOS leads to: decrease insulin resistance, and increase SHBG
which decrease free Androgens.
Klinfilters and Mumps orchitis after puberty can cause 1ry testicular failure.
Postpartum thyroiditis (3-7 months after labor): the same clinical data as hashimotos
Ds. Treatment: Low dose thyroxin, withdrawn after 6 month to measure the
success of treatment.
In insulinoma fasting test: the cutoff value after 15 hrs fasting of glucose 2.5 mmol
and 5 mu/l insulin.
DM who wishes to exercise heavily are advised to use basal insulin bolus instead of
mixed insulin.
Diabetic Amylotrophy (usu. involves sacral plexuses): Require control with insulin.
Nephrology:
Cholesterol emboli: Low C3, eosinophilia, Increased ESR and Urine protein.
Oral Iron in not well absorbed in patients with CRF, thus should be given in IV form.
ADPCKD: its recommended to screen patients after 20 yrs. old in high risk group.
Normal urine: Can contain red cells, granular and hyaline casts.
Calciphylaxis: Occurs in patients with CKD, Ulcers with calcified blood vessels.
Anemia with CKD: if ferritin<100 and/or transferrin<20% treat with IV iron first.
Post cranial surgery DI: Treated initially with proper fluid replacement.
Treatment of SBP from long term peritoneal dialysis: IP gentamycin and vancomycin.
Iron deficiency anemia should be corrected before starting CRF patients on EPO.
Hematology
Acanthocytosis: cc by spur bodies in peripheral blood, hemolytic anemia, fat mal-absorption
symptoms, movement and CNS problems esp. 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 and safety), Phase III
(comparison with another drug), Phase IV (post marketing).
In patients with lab finding of DIC without obvious symptoms: Treatment is directed 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.
Stains in hematology: 1. TARP +ve: Hairy cell leukemia. 2. Sudan Black and myeloperoxidase
+ve: AML 3. TDT +ve: ALL 4. LAP High: PRV, and Myelofibrosis, Low LAP: CML.
Difference between Alpha thalassemia minor and Beta thalassemia minor is HbA2
(decreased in A TM, Increased in B TM).
Rheumatology
In shrimer test for Sjogren syndrome: The wetting of the filter paper should be at least 4
mm after 5 mins.
First line in treatment of 1ry Osteoporosis is Bisphosphonates.
Difference in vertebral affection between AS and Psoriatic arthritis is symmetry and nonsymmetry, respectively.
Factor V leiden increase the risk of venous thromboembolism only if patient uses OCP.
ANA +ve in 60-90% of SS, while other antibodies specific for SS is +ve in 50% only.
Drug that can be used for RA during pregnancy: Sulfadiazine, Azathioprine (not in breast
feeding)
Charcot Joint (increase osteoclastic activity): Severe joint destruction with minimal
symptoms. (DM, Syphilis, Leprosy, syringomyelia). DDx: indium radiolabelled WBCs.
Treatment: Immobilization+/-Bisphosphonate.
Adult onset Stills Disease: Fever, Weight loss, Arthralgia/Arthritis, Anemia, HSM+ve and
Lymphadenopathy.
Anti TNF must be stopped 2-4 wks before major surgery (Because it interfere with wound
healing).
T- score of -1.5 is a cutoff value to start osteoporosis treatment in steroid user patients.
Electromyography and nerve conduction: Used for confirmation of Carpal Tunnel Syndrome
before surgery.
Drug induced Lupus: ANA +ve, RF +ve, Antihistone +ve, and Normal Comp. level.
Discoid Lupus: Form of lupus with scarring photosensitive skin manifestations is the main
symptoms.
The most common Lung manifestation in Lupus is Pleural effusion and pleuritis.
Anti dsDNA is confirmatory for Lupus and correlate for disease activity.
Proprionibactirum Acne: Common gram +ve organism found in hip prosthesis during time of
revision (Asymptomatic).
Rubricase: Used in the treatment and prevention of gout associated with tumor-lysis
syndrome.
There is a variant in Huntington chorea that expressed in youth (Early), with associated
Parkinsons symptoms.
New variant CJD: affects young age and EEG is variable unlike sporadic CJD.
Normal pressure hydrocephalus triad: starts with gait disturbance, cognitive deterioration
then urinary incontinence.
Lumbar puncture and nerve conduction studies can be normal early in GBS.
Mononeuritis multiplex: improves over 6 month period with occupational therapy and
physiotherapy.
Holmes Aides eye: dilated sluggish reactive pupil, with decreased reflexes of body.
Friedreich ataxia: cerebellar symptoms, pes cavus, heart hypertrophy, areflexia and spastic
paralysis.
Giant cell arteritis: Associated with anterior chamber ischemic optic neuropathy (painless
loss of vision).
Anticoagulant is given in vertebral artery dissection (use MRA to confirm) to prevent distal
thromboembolism.
Thyrotoxicosis is associated with periodic paralysis (Hypokalemia).
Pituitary Apoplexy (hemorrhage inside the gland): causes bitemporal hemianopia,
hypopituitarism.
Occulomastactory Myorrhythmia: in whipples (Nystagmus, upward gaze palsy and 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 upper brachial plexus,
painless and associated with lymphodema.
Deja vu, epigastric sensation, followed by loss of consciousness and oral automatisms:
Temporal lobe epilepsy (complex partial seizure, Hx of febrile seizures).
Locked in syndrome: occlusion of basilar artery, quardripelgia, only blinking and upward
gaze is present.
EEG in herpetic encephalitis shows front-temporal wave slowing, with intermittent sharp
wave complexes.
Annual Fundoscopy is offered to people with DM1 and DM2 with normal retina.
Causes of isolated 6th nerve palsy: MG, Sarcoidosis, Thyrotoxicosis, MS, and GCA (old Age).
MS: Worsening of symptoms a hot bath.
Temporal lobe lesion causes: Contralateral superior homonymous quardrantanopia, while
Parietal lobe causes contralateral inferior homonymous quardrantanopia.
Wilson Disease: Causes extrapyramidal signs, emotional liability, personality changes and
depression.
Carotid artery dissection: cause lower cranial nerve palsies (VII, Hypoglossal).
Organism associated with GBS: Campylobacter, Chlamydia, Hep B, EBV, HIV, HZV, CMV
and Mycoplasma.
First line of Idiopathic Parkinsons disease treatment: <75 year old--Dopamine agonist
(parmipexole, ropinirole), > 75 yrs old--Levedopa.
Toxoplasma Chorioretinitis : Unilateral, mild ocular pain, blurred vision (hazy), White yellow
lesions in fundoscopy.
Feredirech Ataxia: Upper and lower MN lesions, Sensory affection, Atrophy of small muscles
of hand, Ataxia, and nystagmus.
GBS causes Nerve demyelination (Slow conduction and Blocked at several intervals).
Ependyoma: Tumor arises near filum terminal in spinal cord causes chronic back pain +/Saiatica and increased T2 signal on MRI.
Pontine lesions are associated with convergent squint (due to lateral rectus palsy).
Cerebral venous sinus thrombosis: Headache, Focal motor and sensory sign, Papilledema. RF:
Increased coagulopathy. DDx: MRV. Tx: Heparin followed by warfarin.
Glomus Jagulare Tumor (vascular tumor) arises near jugular foramen (compress VII, IX, X,
XI and causes conductive hearing loss.
Tropical spastic paresis (HLTV-1 associated myelopathy): UMNL in legs that is contagious.
Inclusion Body myositis (most common acquired myopathy): Affects quadriceps and long
flexors. CPK increased but not much.
Huntington Disease: CC by behavioral disturbance with suicide ideation and abnormal eye
movement (slow saccades).
Vertebral artery dissection: can be associated with Lateral or Medial medullary syndrome.
Sarcoidosis can cause basal meningitis with lower cranial nerve palsies as a complication.
Kearn Sayre Syndrome (mitochondrial disorder): Loves eye (Opthalmoplegia (upward gaze),
Ptosis, Retinitis pigmentosa. Cardiac symptoms. Cerebellar symptoms.
Carotid angiography: is the gold standard in diagnosis of Carotid Dissection, although non
invasive technique can be used e.g. Carotid duplex.
PSP: Upward and Downward gaze can be affected before horizontal one.
You can drive the car after 6 month in unprovoked seizure (after being assessed), 3 years
in seizure during sleep and night.
Carotid artery dissection: Posterior Neck pain may be the only presenting symptom, Cranial
nerve palsies, and stroke. Treatment: Anticoagulant.
Vertebral artery dissection: Severe neck and occipital pain, symptom of cerebellar
affection.
Antidyslipidemic should be used in the 2ry prevention of CVA, even if the cholesterol
normal.
Painful 3rd nerve palsy: Due to vascular lesion (posterior communicating artery aneurysm,
DM (ischemia), and coarticoaortic fistula.
Benign Coital Headache (variant of migraine): Acute severe headache happens with or after
orgasm (due to autonomic dysregulation). DD. Subarachnoid hemorrhage.
Interferon B is used in MS to reduce relapses. Steroids are used during acute attacks.
Sciatic nerve palsy (L4:S3): Supply all muscles of the lower leg.
Wernicke Encephalopathy Triad: Ataxia, opthalmoplegia and delirium, also there may be
hypoglycemia, Hyothermia and hypotension. Can occur in any malnorshiment (e.g.
Hyperemesis gravidarum).
Carotid Artery Dissection: Intracranial type headache + Stroke, Extra-cranial type: Neck
swelling + 9, 10, 11 cranial palsies + Horners.
Intra-cecal Lymphoma: Associated with increased oligoconal bands and decreased glucose
in CSF.
Chronic Headache syndrome (overuse of pain killers): starts with tension or migrane
headache. Treatment: Discontinue pain killers, amitrypitaline.
Anterior inferior cerebellar artery (lateral lower pontine infarction): Affection of cranial
nerve 8, 7, conjugate eye movement and Horner syndrome.
Burning limbs after exercise, hot weather or febrile illness in Fabrys Disease.
Critical illness myopathy: Proximal myopathy in critically ill persons receiving muscle
relaxants and steroids.
Lock in syndrome: infarction of proximal and middle basilar artery segments (Brain stem),
bulbar and UMNLs. Distal lesions are CC by deterioration in consciousness.
Inpatients suffers from stroke, should be transferred to stroke unit for better result.
Lewy body dementia (visual hallucinations and Parkinsonism with fluctuating dementia):
treated by Anticholinesterase.
Indications of carotid endarterectomy: the more the risk factors, the more is the benefit.
MG: Anti acetylcholine receptor positive in 90%, while the remaining 10% can be diagnosed
with anti specific muscle kinase.
Weber syndrome--Eye (Midbrain lesion in cerebral peduncle): 3rd nerve palsy, contralateral
hemiplegia (flaccid paralysis + up going planter reflex).
Gretsmanns syndrome (dominant parietal lobe lesion): Finger agnosia, left to right
disorientation, dysgraphia and achalcula.
MG: is exacerbated with pregnancy, and usually associated with other autoimmune
diseases.
Brain tumors: is generally not chemosensitive. Whole brain radiation is used for multiple
brain metastasis, while sterotactic radiotherapy is more localized for specific lesions.
Juvenile myoclonic epilepsy (early onset): Myoclonic jerks (worse in the morning) +
Generalized tonic clonic + absence seizures. First line: Valproate.
ASA is used for 1ry prevention of stroke, while it is switched to clopidogrel in 2ry
prevention.
Electromyography: can be used to confirm myotonic dystrophy (waxing and waning potential
Dive bomber), instead of biopsy.
PML: Presents with Visual, cognitive, behavioral, motor, and masses on Head CT in
immunocomporomized.
Herpes Zoster Opthalmicus: Can lead to serious eye complications if not treated.
Acute Histoplasma infection: can presents with glandular fever and erythema nodsum.
The most common organism causes meningitis after shunt operation for hydrocephalus is
staph epidermides.
Salmon Colored rash in: Typhoid Fever.
Tick Typhus (R.Conori): Causes black eschar + Lymphyadenopathy. Tx: Doxycycline.
HIV can be associated with TTP and should be excluded on clinical suspicion.
Meningitis associated with fracture skull base: IV linezolid should be given (covers staph
aureus and epidermidis)
Alopecia and Apthous ulcer is a common association with 2ry syphilis.
Difference between oral hairy leukoplakia and oral candidiasis is that patches are dislodged
easily in candidiasis.
Parvovirus causes anemia in HIV persons Treated with IV Igs.
When PO2 <9.3 (70mmHg), start IV steroids in PCP.
Exudative pharyngitis + Swollen neck (bulls neck)= Dipthiteria.
HSV >6 attacks per month, Aciclovir given for 3 months.
Typhoid Fever: FAHM, diarrhea or constipation, Cough, Salmon colored rash. (D.D. Malaria).
Treated with Ceftriaxone (or Amoxicillin, Ciprofloxacin (high resistance)).
Slapped Cheek Disease (Caused by Parvovirus): Causes Fetal Anemia and Hydrops fetalis.
Treatment IV IGs.
Dengue Fever is either a hemorrhagic fever, rash, FAHM, early lymphocytosis, later
lymphopenia, thrombocytopenia and anemia. Or a simple (remitting) fever, sweating,
lymphadenopathy, maculopapular rash. Treatment: Supportive.
Allow 48 hrs after giving antimalarial to see an effect on parasitaemia (>10% exchange
transfusion).
Chancriod (H.ducrei) is treated by macrolides or quinolones.
Ciprofloxacin+ Loperamide: reduce the severity of traveler diarrhea.
Malaria prophylaxis should be continued 7 days after return using Atovaquone/proguanil or 4
weeks using mefloquine alone.
Drugs used in the prophylaxis of meningitis: Rifampicin, Ciprofloxacin (First line, 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 be chronic),, GI
symptoms (can be chronic), eosinophilia, rash (may be linear) Treatment: Ivermectin or
Albendazole.
Zidovudine: Associated with fat distribution and Hyperglycemia.
Nucleoside reverse TI: Associated with cardiomyopathy.
Pinta (trepenoma): Hyper-pigmented skin lesions.
Dermatology:
Necrobiosis Lioidica (in DM): Lesions on front 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 to sunlight.
Drug Hypersensitivity syndrome (3-6 weeks after starting the drug): Fever, Facial edema,
popular and pastular rash and lymphadenopathy.
Lupus Vulgaris: Scarring skin lesions due to T.B infection. Treated with Anti T.B.
Herpetic Whitlow (HSV affecting fingers): cause herpetic rash, cellulitis, lymphadenitis
and lymphedema.
Stevens-Johnson syndrome: Erythematous papules and blisters affecting body and mouth,
conjunctive and genitalia.
Seborrhoeic Keratoses (senile warts): in old age, stuck on appearance, usually on the back.
People showing dermatitis herptiforms rash for coeliac 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).
Oral leukoplakia: White lesions at the side of the mouth that cant be dislodged caused by
smoking and alcohol.
Dermatitis Artifacta: Self inflected linear or geographical lesions that appear overnight.
Rosacea (photosensitive): erythema with telangiectasia, papules and pastules mimicking acne
but no comedones, swelling and distortion of nose. Treatment antibiotics.
Oral acyclovir is useful only if given in the 1st 48hrs after HZV infection.
Yellow nail syndrome: in bronchiectasis, COPD, pleural effusion, nephrotic syndrome and
penicillamine use.
Erythema gyratum repens: Wood grain rash appearance, associated with malignancy.
Phenytoin (can cause increased liver enzyme) and Carbamazpine: causes cerebellar
toxicity.
Long term antiepileptics are not required in treatment of acute alcohol withdrawal,
instead IV lorazepam can be used for prophylaxis.
Treatment of digoxin related VT: 1st line IV phenytoin, 2nd line lidocaine.
Multiple dose charcoal can be given with overdose of: Carbamazipine, Digioxin,
Dapsone, Theophylline, phenobarbital, salicylates and Qunine.
Calcium Alginate: used in the dressing of bed sore with necrotic tissue.
Using antibiotic once daily is safer than using multiple doses in nephrotoxic
antibiotics.
Latent T.B (+ve blood test without symptoms and signs of T.B): Rifampicin + INH
for 3 months.
Atenolol causes IUGR in pregnant, while labetalol and nifidipine are safe.
Donepezil side effects (CNS stimulant): Irritability, hallucinations, insomnia and seizures.
Drugs following zero order kinetics (Peas and WHEATS): Phenytoin, warfarin, heparin,
ethanol, aspirin, theophylline, salicylates.
Sodium Valproate (can cause PCOS like syndrome): 1st line in absence seizure
Fullers earth is given post paraquat ingestion, if not found and within 4 hrs of ingestion
activated charcoal may be given.
Hyperkeratosis of skin of palm and soles, with transverse line on nails: Arsenic poisoning.
Dot sign in sylvian fissure: sign of brain infarction (MCA). Treatment thrombolysis.
Cord compression: Dx. best with MRI. Treatment: IV steroids +/-surgery or radiation.
Bony metastases: associated with hot spots in bone scan (may be osteogenic or osteolytic).
Patient with pretreatment of myeloprolifirative disorders high LDH, is at risk of tumor lysis
syndrome.
Poor prognosis of Ewings sarcoma in: male, >12 years old, anemia, increased LDH, poor
response to chemotherapy.
Small cell carcinoma is almost always disseminated by the time of diagnosis. Treatment
chemotherapy+ Radiotherapy.
Pupil of Horner syndrome caused by pancosts syndrome doesnt dilate with atropine.
Upper and middle esophageal cancer needs bronchoscopy to exclude tracheal involvement.
Hodgkin Lymphoma occurs in relatively young age, while non-Hodgkin occurs in old age.
Testicular choriocarcinoma: can be small size and not detected with clinical exam,
associated with markedly high bHCG, normal AFP and CEA, and early metastasis to lung.