revise for mrcp part 2 written - you 2c ahmed

Aortic dissection: associated withinferior MI, Type A proximal:require surgery.. Peripartum Cardiomyopathy: inpregnancy, presents in the lastmonth or within five months ofdelivery, systo

Revise for MRCP

part 2 (written) in 5 days

Bullet point facts on high yield topics

as they appear in the

exam based on themes from past

examination papers

Dr Ahmed YousifMUDr MRCP (UK)

1st Kindle Edition

Copyright © Ahmed Yousif

The Author asserts the moral right to be identified as

the author of this work All rights reserved.

No part of this publication may be reproduced, stored

in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of

the publishers.

Kindle edition by EBooks by Design

www.ebooksbydesign.co

Preface

Cardiovascular Medicine Gastroenterology

Infectious Disease Respiratory Medicine Rheumatology

Drugs & Toxicology

The ebook is intended as a quick revision for busy SHOs and foundation doctors who are preparing for their MRCP part 2 (written) This concise ebook offers bullet point facts as they appear in the actual exam paper based

on themes from past examination papers The topics are randomly set to mimic the random nature of MRCP examination questions Whether you are prepared for the exam and would like a quick revision, or you are running short of time you will find the book very useful and straight to the point The fact that it’s an ebook

means that it’s easily accessible to busy doctors while they are on duty or oncall shifts, whether they are using their AMAZON KINDLE, IPAD, IPHONE, or PCs The book may also

be useful for registrars who would like

to refresh their memory on MRCP topics Good luck.

‘To My loving parents Without theirknowledge, wisdom, patience, andguidance, I would not have the goals Ihave to strive and be the best to reach

my dreams’

WPW syndrome with narrowcomplex tachycardia: adenosine,then iv flecanide, if unstable DCcardioversion (avoid verapamil &digoxin as they increase conductionthrough the accessory pathway) Primary pulmonary hypertension:

SOB, RVF, ECG: right axisdeviation, tall R in v1 v2, causes:idiopathic, HTN, HIV, obesity

portal hypertension Dx Echo,Cardiac catheterisation (raisedpulmonary artery pressure) Rx:O2, Ca channel blockers, ivprostacyclin, oral anticoagulant,phosphodiestrase inhibitors

New onset AF: first anticoagulatewith LMWH then flecainide 300

mg, if patient becomes hypotensive

or CP or heart failure then DCcardioversion

Stent thrombosis occurs 2 days postangioplasty, tx with iv abciximab,heparin, aspirin then urgent

Pericarditis: chest pain worse onlying down, ST elevation in ECG,raised inflammatory markers & CK,

Carotid sinus hypersensitivity:

patients present with collapse Rx.Dual chamber pacemaker.

Endocarditis following colonicresection maybe caused by Bacillusfragilis

Aortic dissection: associated withinferior MI, Type A (proximal):require surgery Type B (distal):conservative management, control

BP with labetolol

ACE inhibitors are contraindicated

in aortic stenosis as they mayprecipitate heart failure

Polymorphic VT: if patient is stabletreat with iv magnesium infusion,overriding pacing If patient is

Peripartum Cardiomyopathy: inpregnancy, presents in the lastmonth or within five months ofdelivery, systolic heart failure &pulmonary oedema ECG may showLVH 50% recover full cardiac

function within six months Rx.Heart failure treatment (avoid ACEinhibitors in pregnancy).

Carcinoid syndrome: flushing,diarrhea, wheeze, abdo pain,tachycardia, assoc with MEN1 &2,malignancy, 5HIAA + in urine, Rx.somatostatin (octreotide) orsurgery

Chromogranin A is blood markerfor carcinoid tumour

Ulcerative colitis with colonicdistension not responding tosteroid: if distension is less than5.5 cm try cyclosporine

Ulcerative colitis complications:

toxic megacolon (Rx iv fluids, ivabx, surgical review), perforation(CXR: air under the diaphragm) Achalasia: dysphagia of solid &liquids, aperistalsis, increased LOStone, Dx Barium swallow, Rx.Botulinum toxins, surgery.

Duke C colon adenocarcinoma isthe most common lower GImalignancy

Reye’s syndrome: encephalopathy,fatty liver, elevated transaminasepost infection, cerebral oedema:

Rx Iv mannitol & intubation

Anorexia nervosa: thin, normocyticanaemia, hypokalaemia (laxatives),hypocalcaemia (dietary), metabolic

alkalosis (vomiting), high amylase(vomiting), lanugo hair.

Diverticulitis: LIF pain &tenderness, fever, diarrhoea Dx

CT abdo Rx IV abx, surgicalreferral

Ulcerative colitis: bloody diarrhea,anaemia, hypoalbuminaemia,pANCA+, large bowel dilatation

Severe exac Of UC: frequency ofbowel motions, temp, HR, ESR,

anaemia Rx IVI, iv steroids, s/cheparin, elemental diet.

CXR: air under the diaphragm:perforation, maybe 2nd to UC

Microscopic colitis: waterydiarrhea, normal colonoscopy,inflammation of lamina propria

GI bleed: iv omeprazole improvesprognosis

Unidentified GI bleed: capsuleendoscopy, mesenteric angiography

or CT angio

Pharyngeal or oesophageal pouch:dysphagia to solid & liquid, noweight loss, slight anaemia Dx.Barium swallow

Drug induced pancreatitis: steroids,

azathioprine, tetracycline,metronidazole, valproate,furosemide, octreotide, cimitidine Coecliac disease is associated withNHL.

Pyoderma gangrenosum: affectspatients with IBD, sometimes

prednisolone

Auto immune hepatitis: (plasmacells), Type 1 (ANA,Anti-SMA),Type 2 (Anti-LKM)

High fasting gastrin levels:zollinger-Ellison syndrome,pernicious anaemia

Familial adenomatous polyposis:

AD, tendency to colorectal cancer

at 40s, hypertrophy of retinalpigment epithelium, fibromas,epydermoid cyst, supernumeraryteeth Follow up with colonoscopy

& removal of large polyps

Hamartomatous polyps: Cowdensyndrome>polyps & oralpapillomas+thyroid dysfunction,Puetz jegher> histology smoothmuscle arborisation &hyperpigmented macules on lips &oral mucosa FAP> polyps &retinal pigmentation Gardner’ssyndrome>polyps, osteomas,fibromas, & sebaceous cyst

HNPCC: mutation in DNA

mismatch repair gene, associatedwith endometrial & ovarian cancer,gastric adenocarcinoma, brainglioblastoma Follow up: 20-40year old need colonoscopy every 2years, above 40 need annualcolonoscopy.

Senna causes dark pigmentation ofcolon (melanosis coli)

Boerhaave’s syndrome: rupture ofoesophagus, epigastric pain,vomiting, pleural effusion, surgicalemphysema Dx Gastrograffinswallow Rx Surgery

Primary biliary cirrhosis: In middleage women, anti-mitochondrialantibodies, pruritis, tiredness,jaundice, raised ALP, associated

with autoimmune disease such asSjogren’s Dx Needs liver biopsyfor staging Rx Urodeoxycholicacid, liver transplant.

Primary sclerosing cholangitis:

malabsoption of fat, steatorhea, Dx.ERCP, MRCP Rx Urodeoxycholicacid, liver transplant

Meig’s syndrome: ovarian fibroma,ascites, pleural effusion

Budd Chiari syndrome (hepaticvein thrombosis): associated withantiphospholipid syndrome,abdominal pain, hepatomegaly,ascites, renal failure Rx.Anticoagulation

Zollinger-Ellison syndrome:multiple ulcers, diarrhea, lowVitamin B12, raised fasting gastrinlevels (stop PPI for 1 wk beforetest) Rx PPI, octreotide (reducegastrin levels).

Achalasia: oesophageal motilitydisorder, dysphagia, regurgitation,chest pain, increased loweroesophageal sphincter pressure

Dx Oesophageal monometry,barium swallow Rx Nifedipine,botox, surgery

Small bowel occult bleeding isdiagnosed by capsule endoscopy

Diabetes, endocrinology, &

metabolic disease

Diabetes retinopathy: in type 1screening starts after the first 5 yrsannually and after 10 yrs 6 monthly.For type 2 screening is annually Hypercalcaemia:

hyperparathyroidism, sarcoidosis,malignancy

Cryoglobulinaemia:

immunoglobulins precipitate whenblood is cooled in the skin Assoc.with hep C, SLE, RA, Sjogren’s.Causes glomeruloephritis,

vasculitis, thrombosis,polyneuropathy, raynaud’sphenomena, leg ulcers Rx Plasmaexchange & chemotherapy.

PCOS: amenorrhea, hirsutism,metabolic syndrome & insulinresistance, infertility, Dx USS, LH

to FSH ratio > 1.1

Pellagra: nictotinic acid (niacin)deficiency, dementia, depression,dermatitis, diarrhoea, insomnia B1 (thiamine) deficiency causeswet beriberi (heart failure,peripheral oedema) or dry beriberi(neuropathy)

UTI in uncontrolled diabetes maybecaused by Candida sp

Polyglandular syndrome type 1:candidiasis, hypothyroidism,addisons

Polyglandular syndrome type 2:hypothyroidism, addisons, type 1

DM, coeliac disease, myastheniagravis

Pregnancy: raised prolactin, breasttenderness, amenorrhea

Glucagonoma is associated withnecrolytic migratory erythema,diabetes Rx Octreotide

Acromegaly: IGF-1 & glucosetolerance test

Diabetes insipidus: waterdeprivation test: serum osmolality

>308 then patient has DI & test is

stopped If urine osmolality >800then primary polydipsia.

If urine osmolality remains <300,then do desmopressin test: if urineosmolality raise >800 then itcranial DI, if urine osmolalityremains <300 then its nephrogenicDI

Papillary carcinoma is the mostcommon thyroid carcinoma, spread

to cervical lymph nodes, assoc withfamilial adenomatous polyposis

Rx Thyroidectomy & radioiodineablation

Polyuria & polydepsia :hyperglycaemia, hypercalcaemia,

DI, hypokalaemia

Primary hyperparathyroidism: high

PTH, high Ca, low PO4, Polyuria

& polydepsia, bone pain &pathological fractures, weight loss,constipation, renal stones Causes:mostly adenoma, but rule out

Bisphosphonate, Surgery (maydevelop hungry bone syndromepost-op with low Ca, PO4 & lowMg)

Secondary hyperparathyroidism: inchronic renal failure due to raisedPTH & hypertrophy of parathyroidgland in response to low calcium

Rx Calcitriol

Pentagastrin stimulation testmeasure calcitonin in 2 & 5 min,raised levels indicate medullary

thyroid carcinoma in MEN2.

In secondary hyperparathyroidism(CRF) not responding to vit D usecinacalcet to reduce PTH

In myxoedema coma: may co-existwith addison’s so need both ivthyroxin & iv hydrocortisone untilproven otherwise as thyroxinealone may worsen addison’s

hyperkalaemia, cushing disease:

hypertension

Hyperprolactinaemia: 1st excludepregnancy as the most commoncause Macroprolactinoma >6000

Rx 1st line is dopamine agonistsuch as bromocriptine orcabergoline, then surgery ifresistant to medical Rx.

Gestational diabetes: try diabeticdiet for 1-2 wks if this fails

glibenclamide, then insulin

Neurofibromatosis type 2: acousticshwannoma & meningiomas

Type 3 hyperlipoproteinaemia(Dysbetalipoproteinaemia): palmarxanthoma is pathognomonic.Mutation in apoprotein E Highcholesterol & triglyceride

Familial hypertriglyceridaemia:eruptive xanthoma on extensor

surfaces, retinal vein thrombosis,recurrent pancreatitis Rx.Finofibrate.

hypercholestrolaemia presents astendon xanthomata whereashomozygous present as CAD inteens with cholesterol above 16mmol

Homocystenuria: AR, methioninemetabolism, resembles marfan’s,short-sighted, downward lenssubluxation, legmentous laxity,thromoembolism, MI, seizures,mental retardation, livedoreticularis Dx Homocysteine inurine & liver biopsy Rx.Pyridoxine, folic acid

In testosterone replacement do FBCand PSA to exclude complications

of polycythaemia and Ca prostaterespectively Do the NADIRtestosterone to check adequatereplacement

Osteomalacia: have low calcium,low phosphate, and raised ALP G6PD deficiency: X-linkedrecessive, most common humanenzyme defect, haemolytic anaemia,Heinz bodies (inclusion with RBC

haemoglobin), precipitated byoxidant drugs (antimalarial,dapsone, quinidine ect)

thyrotoxicosis: Type 1> raisediodine>raised thyroxin>Rx.Carbimazole Type 2>destructivethyroiditis>Rx Prednisolone.

Wilson’s disease: psychiatricsymptoms (depression, neurosis),

(extrapyramidal signs), liverdisease (hepatomegaly, raised

ceruloplasmin, reduced copper,raised urinary copper, Kyser-Fleisher rings detected with slitlamp Rx Reduce copper in diet,D-Penicillamine

Pseudohypoparathyroidism: AD,resistance to PTH & TSH, shortstature, short phalanges, cognitive

impairment, biomedicalhypothyroidism (raised TSH withnormal throxine), low Calcium,raised phosphate.

MEN 1: gastrinoma, insulinoma,hyperparathryroidism,

hyperpituitarism MEN 2a:hyperparathyroidism, thyroid

pheochromocytoma MEN 2b:thyroid medullaru carcinoma,pheochromocytoma, marfanoidbody, mucosal neuroma

Renal Medicine

Flash pulmonary oedema &hypertension in young (<50) =fibromuscular dysplasia, in oldpatient with vascular pathology =renal artery stenosis

Scleroderma renal crisis: malignanthypertension, fluid retention,microangiopathic haemolyticanaemia (helmet cells), Rx ACEinhibitors

Macroscopic haematuria: Dx CTwith contrast, urine microscopy,then cystoscopy

Sore throat & ARF: rapidlyprogressive glomerulonephritis, Rx

Iv methylprednisolone

glumerulonephritis: 3 to 4 wks postinfection, black tea urine, nephriticsyndrome

Membranoprolefrative

Glumerulonephritis is associatedwith Hep B

Nephrotic syndrome is associatedwith prothrombotic state hencerenal vein thrombosis

haemoptysis, haematuria, rapidlyprogressive glumerulonephritis(crescentic) Dx anti GBM Rx

immunotherapy is used.

AKI after infection and penicillin>acute interstitial nephritis, alsocaused by omeprazole & loopdiuretics

Minimal change disease: 90% ofnephrotic syndrome in children,renal impairement is rare Rx.Prednisolone (also caused bylymphoma & NSAID)

IgA nephropathy: present withhaematuria, proteinuria, associatedwith Henoch schonlein purpura,celiac disease, & cirrohsis Rx BPcontrol with renin angiotensinblockers.

Membranous glumerulonephritiscauses: idiopathic, HepB, HepC,gold, penicillamine, SLE, neoplasia(bronchial carcinoma) Rx.Proteinuria> BP control with ACEinhibitors, nephrotic syndrome>steroids

Focal segmental GN causes:idiopathic, obesity, HIVnephropathy, solitary kidney,wegner’s, heroin use Rx.Proteinuria> BP control with ACE

inhibitors, nephrotic syndrome>steroids.

Metabolic acidosis with normalanion gap: diarrhoea, RTA,ureterosigmoidoscopy,

acetazolamide, TPN

Type 1 RTA (distal): metabolicacidosis(HCO3<10), normal aniongap, low K, nephrocalcinosis,renal stones, associated with SLE,Sjogren’s, lithium

Liddle syndrome: hypokalemia,low renin-aldestrone, hypertension,metabolic alkalosis Rx Amiloride,spironolactone (Conn’s=highaldostrone)

Bartter’s: AR, in childhood,