final moment pre exam..toha_tohty_2.pdf
TRANSCRIPT
2
بسم هللا الرحمن الرحيم
شيت اللحظه االخيره
FINAL MOMENT PRE EXAM
ف هتحتوي ع تجميعات مهم ورقه 25عباره ع
الميدسن واشهر توكسيستي من االدوية
لهدا النه صعب تلحق ع المنهج قبل االمتحان بيوم
فيه اغلب الحاجات الضروريه التي تستحق
ف اجتياز امتحانكم بعون هللا تساعدكمو المراجعه
PRESENTED BY
DR_WAEL MOHAMMED
FOR U > GLORY MOM <
G^OO^D LUCK
DATE OF PUPLISHING: 24-9-2015
3
HEMATOLOGY
�B.Thalassaemia major� �Autos.Recessive
�⬇Synthesis of B.globin �Hypochromic+Microcytic
�⬆S.Iron �Need:�
�HB.vaccin �Desferrioxamin
�Folate
�In B-Thalassemia major� �⬆Serum iron
�⬆Serum ferrtin �⬆Hb F
�⬆Hb A2 �⬇MCH
�⬇MCHC �⬇Iron binding capacity
�Anisocytosis + poikilocytosis
�Hormonal disturbance in Thalassemia��
�Blood transfussion➡Iron overload�
1�Hypogonadism 2�Hypothyroidism
3�DM
4�⬇Growth hormone▶⬇ Growth
�Substant Give《Benifit》 In 《
Thalassemia Major》�
1�Vitamin C ➡ ⬆Iron excretion in urin by deferoxamin
2�Folic acid
3�Tea ➡ ⬇Iron absorption
�Indication Of Splenectomy In B.Thalssemia Major�
1�⬆Or Frequent Blood Transfusion
2�Hypersplenism
3�Mechanical Discomfort➡Very Larg Splen
�In Iron Deficiency Anaemia� �⬇Hb
�⬇PCV �⬇MCV �⬇MCH
�⬇Ferritin �⬇S.Iron �⬆RCW �⬆TIBC
�⬆Transferrin �Thrombocytosis
�Microcytic �Hypochromic
�What Is Most Sensitive Test To Dx Iron Deficiency Anaemia❓�
�Low serum ferritin�
�Symptoms Linked To《Iron-
Deficiency Anemia》� �Depression
�Angina
�Dysphagia➡Esophageal Webs
➡ Plummer-Vinson syndrome �Restless legs syndrome
Indications for IV iron: ➡️intolerant to oral
➡️absolute non compliance
➡️high iron requirement
➡️GI malabsorption
�《Iron posioning 》May Lead To�
✳Haematemesis
✳Radiopaque pills on x-ray
✳Later▶Intestinal stricture
�Give 3 Indication Of《 Bone
Marrow Transplantation》� 1◼Thalassemia
2◼ALL 3◼Aplastic anaemia
�Give 4 Causes Of Microcytic Anaemia����
1�Iron deficiency anaemia 2�Thalassemia
3�Sideroblastic anaemia
4�Led posioning
�Give Specific Indication Of Surgery In
《Hereditary
Spherocytosis》◼
1�Splenectomy▶ For Rx of anaemia
2�Cholecystoectomy▶ For Gallstone
�Simple C/P Of ITP, Aplastic
Anaemia&ALL� �ITP
Healthy No splenomegaly
�Aplastic a Serious ill
No splenomegaly �ALL
Serious ill Splenomegaly
�Give 5 Causes Of Macrocytic Anaemia❓�
1�B12 deficiency 2�Folate deficiency
3�Hypothyrodism 4�Liver dz
5�Alcoholism
�Skin Sign In Dx Anaemia � �Jaundice⇒Hemolysis
�Petechiae⇒ALL �Vitiligo⇒ Pernicious �Cafe au lait⇒Fanconi
�Koilonychia⇒IDA �Clubbing⇒IBD
4
�Give 5《 Bad prognostic》
Feature of《 ALL》❓��� 1�Male
2�Age <1 or > 10y 3�WBC >50,000
4�CNS +Testes involve 5�Philadelphia chromosome
�Give 3 Conditions In Which Increase Risk Of
《Leukemia》❓��� 1�Downś syndrome 2�Bloom syndrome
3�Ataxia-telangiectasia
�《Leukemia》Versus
《Aplastic Anaemia》� �Leukemia�
●Pancytopnia ●Hepatosplenomegaly
�Aplastic anaemia� ●Pancytopnia
●No hepatosplenomegaly
�In《Hodgkin's dz》�
♊Past-History ➡May be
Epstein–Barr virus infection ➡ +Ve
♊Reed–Sternberg cells characteristic histopathologic
finding
�What Is Means By
《B symptoms》❓� 1◼Fever
2◼Night sweats 3◼Weight loss
◼Seen in Hodgkin's lymphoma Important in : �Prognosis
�Staging of dz
�What is feature of 《
Hypersplenism》❓� ◼Pancytopenia ◼Spleenomegaly
�Presented with⤵
✔Anaemia
✔Infection
✔Bleeding
�Major presentation of Vaso-Occlusive Cresis In SCA❓�
1�Painful crisis 2�Priapism
3�Stroke 4�Acute chest syndrome
�Give 4《Immunological dz》Causes
《Lymphadenopathy》� 1�SLE
2�Felty's syndrome 3� Still's disease
4�Drugs: �Hydantoin
�Hydralazine �Allopurinol
�Give 10 Non Malignant Causes Of↘
《 Lymphocytosis》❓� �EBV �CMV
�Varicella �HIV �TB
�Pertussis �Syphilis
�Brucellosis �Typhoid
�Toxoplasmosis
�Give 2《Chemotherapy Drugs
》 Causes《Cardiomyopathy》As Side Effect ❓ �
1�Cyclophosamide 2�Doxorubicine
Causes of Massive
splenomegly
Myelofibrosis
Chronic Myeloid Leukemia
Malaria
Kala-Azar leishmania
�Give 3 Causes Of《Combs Test
+Ve》Haemolytic Anaemia� 1�Autoimmune haemolytic
anaemia 2�Rh isoimmunization 3�Incompatable blood
transfussion
�Steps For Prevention Of Complications Of SCA�
◼Vaccination ◼Preventive antibiotics
◼Blood transfusion ◼Hydroxyurea
◼Bone marrow transplant
�What Is Role Of Hydroxyurea In SCA ❓�
1✴️⇑HbF
2✴️⇓SCA Complications
3✴️⇓Frequency of painful crises
4✴️⇓Blood transfusion
�Causes Of Abdominal Pain In SCA�
️Seqestration cresis ️Gall stone
️Mesentric thrombosis ️Peritonitis
️Pancreatitis ️UTI
️Referr pain
�Advice To Patient With S.C.A�
1�Avoid dehydration 2�Avoid infection
3�Avoid tight clothing 4�Avoid cold
5�Avoid ice cold food 6�Vaccination
�4 Types Of《Cresis》 In
《SCA》� 1�Vaso-occlusive crisis
2�Aplastic crisis 3�Sequestration crisis
4�Haemolytic crisis
�What Is Vaccinatuon Need In
《 SCA》��� �Haemophilus influenzae
vaccine �Pneumococcal conjugate
vaccine �Pneumococcal
polysaccharide vaccine
5
�Give 7 DDx Of《Causes》Of 《
Eosinophilia》❓� 1■Asthma
2■Drug allergy 3■Parasite inf
4■Polyarteritis nodosa 5■Hodgkin dz 6■Addison's dz
7■SLE
�Asplenia � �Absence of normal spleen
function �Cause:�
◼Congenital ◼Splenectomy:
�ITP �Spherocytosis �Thalassemia
◼Autosplenectomy: �SCA
�Give 7 Causes Of
《Low ESR》� �SCA
�Leukemia �Congestive hear failure
�Hyperviscosity �Hypofibrinogenemia �Low plasma protein
�Polycythemia
�Give Side-Effect Of Heparin❓� 1�Heparin-induced
thrombocytopenia 2�⬆Aminotransferase
3�Hyperkalemia 4�Alopecia
5�Osteoporosis➡️Chronic use
�Why《 G6PD assay 》may 《
Falsely normal》 in acute haemolysis��
◼Haemolysis of old RBC
◼Secondary to Reticulocytosis▶Contain normal enzyme
�Give 3 Causes Of《Anaemia》
With《No》《
Hepatosplenomegaly》� 1◼Aplastic anaemia
2◼Chronic renal failure 3◼Blood loss
�What Is Uses Of 《
Erythropoietin》❓�� �To Rx anaemia in⤵⤵
■Chronic kidney disease ■Cancer on chemotherapy
■HIV on Rx
Uses of venesection :-
_polycythemia rubra vera
_ as end treatment of acute
pulmonary edema
_haemocrhromatosis
�Cause Of Splenectomy� �Cong. spherocytosis
�Ch ITP �Trauma
�SpleenTumor �Spleen abscess
�Splenic artery Rupture▶pregnant
�SCA �Thalassemia
�Give 4 dz Need
《Peumococcal vaccine 》❓� 1◼Asplenic patient
2◼Patient with renal disease 3◼Patient with CSF leak
4◼Immunocompromised patient
Give 5《Qualitative》《
Platelet Dysfunction》� 1�Von Willbrand dz
2�Bernard-Soulier syndrome 3�Glanzmann syndrome
4�Uremia 5�Liver dz
Thrombosis and
thrombocytopenia
️DIC
️TTP
️Antiphospholipid
syndrome APS
️HIT
️Malignancy
�Name Most Common
Hereditary 《Coagulation dz
》� ◼Von Willebrand dz◼
■Types 1 & 2 ➡ Autosomal dominant traits
■Type 3 ➡ Autosomal recessive
�Give 2 Conditions Other
Than《 ITP 》Cause 《
Prolonged 》⤵
《Bleeding time》❓�� 1■Von Willebrandś dz 2■Haemollytic uraemic
syndrome
�What Is 《Haematological》
Changes in 《SLE》����
1●Haemolytic anaemia▶Coombś Test +Ve
2●Leukopenia 3●Lymphopenia
4●Thrombocytopenia
6
CARDIOLOGY
�What Is Means By Heart failure :
�Heart can't pump enough blood to meet the body needs
�Right-side heart failure �Heart can't pump enough blood
to the lungs to pick up oxygen
�What Is Mean By Cardiac Cirrhosis❓��
�Chronic right sided heart failure
➡Leads to➡Liver congestion⏩Lead to�
�Liver cirrhosis�
How to differentite between
cardic asthma and nocturnal
bronchial asthma both occur at
sleep and both main symptoms
is cough by history :
First ask pt when the symptoms
develop after sleep:
If develop early after sleep it
cardic asthma due to increase
venous return to heart that lead
to lung congestion in pt with
heart failure
But if symptoms develop late at
night near 3_4 am it mean
nocturnal bronchial asthma is
due to decrease corticosteroid
due to diurnal variation
2nd Q is what you do to relife
symptoms :
Cardic asthmj relife by sitting
and taking air while nocturnal
asthma only by bronchodilator
Also by type of cough dry in
broncial asthma and wet frothy
in cardic asthma
Managment of myocardial
infarction:
1 rest
2 oxygen 65%
3 crushed aspirn 300 mg
4 gtn angised sublingual
>>>ECG<<<
5 morphin iv 5 mg
6 plasil iv10 mg
7 fibrinolytic 100 mg
8 beta blocker
9 plavix
10 heparin 5000 iu
11 tahor
12 zantac
Inv : cardic enzym
Cbc
Random blood suger
Aptt
�Dressler syndrome《Post.MI
syndrome》� �Delayed immune-mediated
�Fever
�Chest pain ➡pleuritic
�Pericarditis ➡ Pericardial friction rub
�⬆WBC
St elevation of pericarditis smile face smile
emoticon concave
St elevation of mi sad face frown emoticon convex
خد وجع متاع بيري كارديتيس يزيد لما يا مريض نفس
جه هوالوع nsaid واولولهم ابروفين ...
Variant Angina =
Prinzmetal's Angina
From coronary Vasospasm
Avoid Beta-blockers
Treat with dihydropyridine
CCB (i.e. nifedipine)
�Give 5 Causes Of《Sinus
Bradycardia》� 1◼Inferior MI
2◼Hypothyrodism 3◼Hypothermia
4◼Athletes 5◼⬆ICP
�Adams-Stokes dz�
◼Disorder of ❤ rhythm ◼Bradycardia
◼Syncope ◼With or without convulsions ◼Third-degree heart block on
ECG during attack
�Give 5 Causes Of《Sinus
Tachycardia》� 1◼Anemia 2◼Exercise
3◼Fever 4◼Anxiety
5◼Thyrotoxicosis
�Give 5 Causes Of《Long PR
Interval》� 1◼First degree heart block
2◼Acute rheumatic fever▶《
carditis》 3◼Hypokalemia 4◼Lyme disease
5◼Drugs
ECG showing flattened P
waves; prolonged PR ;
widened QRS; and tall,
peaked T waves
characteristic of
hyperkalemia.
�About 《P Wave》In The ECG�
�P-Pulmonale�
�Peaked p wave in ➡ lead II
�Causes➡Right atrial enlargment
�Seen in: ◼Chronic asthma
◼COPD
7
�《Site》 Of《Edema》�
◼Early edema ➡seen in : �Priorbit + Legs
◼Late edema ➡seen in : �Sacral + Genital
�Common Cause Of 《Pitting
Edema》�
1�Systemic dz ▫Heart dz ▫Liver dz
▫Kidneys dz 2�Local dz
▫Varicose veins ▫Thrombophlebitis
�Give 3 DDX Of《Non-pitting
Edema》❓��� 1�Lymphedema
2�Pretibial myxedema (Sever Hypothyrodism)
3�Lipoedema
Info :
Drugs cause lower limb edema
1.CCB
2.beta blocker
3.NSAID
�Give 4 Signs Of
《Cor Pulmonale》 ❓� 1●⬆JVP
2 ●Lt parasternal heave 3 ●Hepatomegaly
4 ●Bilateral leg edema
-all type of shock lead to low
volume pulse except septic
shock coz it cause vasodilation.
-high jvp without pulse >>>
superior vena cava obstruction
-syncope due to 3rd degree
heart block called adam stock
attack due to sever bradycardia
lead to low perfusion to brain
�《Pathology》 Of《Bacterial
Endocarditis》:�
1♋Portal of entery for bacteria Eg�Tooth extraction
2♋Abnormal Heart or valve
�Vascular lesions seen in Infective endocarditis�
1�Stroke 2�Splinter hg
3�Janeway lesion 4�Gangren of finger
5�kidney & Splenic infarction
�Single Best Investigation Test
For Detection Of《 Vegetation &
Abscess》 In 《 Infective
Endocarditis》❓�� �Transesophageal Echocardiography
�Name the 《Heart disease》 Causes
[Fingers Clubbing] ❓�� 1□Congenital cyanotic heart dz
2□Subacute bacterial endocarditis
3□Atrial myxoma
�Give 3 Histological Bodies In Diagnosis Of dz◼
�Aschoff bodies� � Rhumatic fever �Negri bodies�
� Rabies �Lewy bodies�
�Parkinson's disease
�Give 3 Cardiovascular causes Of Haemoptysis�
1�Congestive Heart Failure 2�Severe Mitral stenosis
3�Arteriovenous malformation
�Define Cyanosis :�� �Abnormal blue discoloration of the skin & mucous membranes �Caused by ⬆ in deoxygenated Haemoglobin level to > 5 g/dL
�Major Criteria Of Rhumatic Fever�
1�Polyarthritis
2�Carditis➡Serious 3�Subcutaneous nodule 4�Erythema marginatum
5�Sydenham's chorea ➡ Late
�《Minor》 Criteria Of《
Rhumatic Fever》�
1�Fever➡38.2–38.9 °C 2�Arthralgia
3�⬆ESR 4�⬆CRP 5�⬆WBC
6�ECG➡⬆PR interval 7�Previous rheumatic fever
�Complications Of Rhumatic
Fever�❤�
1�Damage heart valves▶Commonly�
●MS ●AS 2�HF
3�Endocarditis 4�Pericarditis 5�Arrhythmias
��Sydenham Chorea���
◼Seen 1-6mo after Rheumatic Fever
◼Early sign➡Poor handwriting ◼Purposeless involuntary
Movement ◼⬆by stress ◼⬇by sleep
8
�Give One《Vitamin Deficiency
》 Cause《Heart Failur ❔�
●Vitamin B1➡Thiamine
●Called ➡ Wet beriberi
�What Is Average《Weight》 Of Human Heart❓�
◼ 300 gm
◼Athletic reach ➡ 500 gm
�Selenium Deficiency Assiociated With:
�Cardiomyopathy�
�What is most common 《
primary tumor》 seen in 《
Heart》 of Adult❓���
� Myxoma �
�Kussmaul sign� �Paradoxical⬆JVP on
inspiration �Seen in�
�Constrictive pericarditis �Restrictive cardiomyopathy
�❤Tamponade �Pulm. embolism
�Name 《Cardiac》 Causes Of 《
Ascitis 》Other Than Heart Failure ❓�
�Constrictive pericarditis�
�Beck's triad❓� �Pathognomonic
for ➡ Cardiac Tamponade �Triad� 1�⬇Bp 2�Distended neck
veins 3�Distant muffled heart sounds
Jugular venous distention is
present in many patients with
cardiac tamponade, but may be
absent in those with severe
hypovolemia.
In patients with an idiopathic
pericardial effusion that has not
resolved by 3 months,
pericardiocentesis should be
performed.
�Give 2 《Syndrome》 May Associated With
《 Mitral Valve Prolapse》❓� 1�Marfan syndrome
2�Ehlerś Danlos syndrome
️Common Symptome Of《
Aortic Stenosis》️️Traid of :
1□ Anginal chest pain
2□ Dyspnea ➡⬆By activity
3□ Fainting
�Dont Forget The 《Notching Of
Ribs》 Is Sign Of 《Coarctation
Of Aorta》 & Due To� ■Collateral circulation■
�Type of ❤ Apex beat��
�Tapping➡MS
�Trusting➡AR
�Forceful➡AS �Impalpable� �Emphysema
�Pneumothorax �Dextrocardia
�Obesity �Pericard effusion
D/D of emergency cases give to
them low molecular wt heparin
:
1_ unstable angina
2_ myocardial infarction
3_pulmonary embolism
4_DKA
�Give 2《Bruits》Occurs In Patient With
《Hypertension》�
◼Enlarged thyroid ➡Bruits in carotid arteries
◼Renal artery stenosis➡ Abdominal bruits
�Antihypertensive Drugs Use
In 《Pregnancy》� �Labetolol
�Methyldopa �Hydralazine �Nifedipine
◼ACE inhibitor➕ Receptor
Blocker➡Contraindicate
️Best Rx For Hypertension
In DM Patient️
️ACE inhibeter️
-toxic goiter : BP & heart
rate both increase
>>>nurogenic shock: both
decrease
> hypovolemic shock and
other shock : Bp=dec
HR=INCREASE
>Increase ICP : Bp=increase
hr= decrease
�What is 《Indications 》of
《Diuretics》❓��� 1■Oedema
2■Hypertension 3■SIADS
4■Nephrogenic diabetes inspidus
5■Idiopathic hypercalciuria
�What is uses of 《
Spironolactone》❓�� �Resistant hypertension
�Nephrotic syndrome
✳Congestive HF
✳Liver cirrhosis
✳Connś disease
9
ENDOCRINE
�What Is The Physiologic Stresses Trigger DKA❓�
1�Infection 2�Truma
3�MI 4�Stroke
5�Pancreatitis
6�Drugs▶Example� □Corticosteroid
�4 Causes Of Fall Potassium During
Rx Of DKA: ◼Insulin therapy
◼Correct of acidosis ◼Ongoing urinary loss
◼Dilutional effect of rehydration
�Give 4 causes of
《Ketonuria》❓���� 1■DKA
2■Hyperemesis gravidarum 3■Fasting 4■Exercise
�Indication Of Surgery For Rx Of DM��
1�Pancreas transplant⏩Type 1DM 2�Kidney transplant⏩End stage
renal dz 3�Weight loss surgery⏩Rx
Obesity
�Give 5 《Endocrine 》Causes Of《
DM 》����� 1�Cushing syndrome
2�Hyperthyroidism 3�Acromegaly
4�Pheochromocytoma 5�Glucagonoma
�Give to《 Infections 》may Cause
《DM》�� 1�Cytomegalovirus infection
2�Coxsackievirus B
�Give 8 Complications Of
《DM》❓��� �DKA
�Infections �Nonketotic hyperosmolar
coma �CVS dz �Stroke
�Ch.Renal Failure �Foot ulcer
�Retinopathy
�Why ⬆Infection In DM❓� �Immune dysfunction
�Micro- ¯o-angiopathies+ neuropathy
�⬇Urin antibacterial activity �GIT & urinary dysmotility
�What Is Main Symptom/Signs
Of《Diabetes Insipidus》❓� �Traid Of ����
1◼Polyuria 2◼Polydipsia
3◼Dehydration
�+Ve Test To Dx DM�
1�FPG⏩ ≥ 7.0 mmol/l⏩126 mg/dl
2�OGTT Plasma glucose ≥ 11.1 mmol/l (200 mg/dl) 2h after 75
g Oral glucose 3�HbA1C⏩≥ 6.5%
�Why Patient With《DM》Presented With
《Diarrhea 》❓��� 1■Autonomic nuropathy
2■Infections 3■Associated with Celiac dz
4■Chronic pancreatitis
�《Fasting blood sugur》
versus 《Random blood
sugar》�
�Fasting▶ After not eaten anything for at least 8
hours
�Random▶ At any time of the day
�3 Main Types Of《DM》❓�
1�Type 1 DM ➡ No enough insulin
2�Type 2 DM ➡Insulin resistance
3�Gestational DM ➡Recover After birth of baby
�What Is《Classic
Symptoms》 Of
《Type1DM》� ◼Polyuria ◼Polydipsia ◼Polyphagia
◼Unexplained weight loss
�Range Value Of HbA1C ���
◼Normal▶ 4% ➖ 5.6%
◼At risk of DM▶5.7% ➖ 6.4%
◼DM▶6.5% or >
�Give 4《 Infection》 Common In
《DM》� 1■Mucormycosis
2■Malignant otitis externa 3■Emphysematous
pyelonephritis 4■Genital candidiasis
�Insulin Uses�
10
�《Gigantism》Versus 《
Acromegaly》� �Both ⬆Growth hormon:
�Gigantism ➡ Befor close of epiphyseal growth plate
�Acromegaly ➡ After close plate
�Give 7 Feature In Acromegaly� 1�Mandible overgrowth
2�Deep thick voice 3�Macroglossia
4�Carpal tunnel syn 5�⬆BP
6�Cardiomegaly 7�Type 2 DM
�Give 3《Blood Investigation》Help For Diagnosis Of
《Cushing syndrome》❓�� 1�Hypokalemia 2�Hypernatremia
3�Metabolic alkalosis
�Monitoring《Side Effect》Of Long
Use Of《Steroid》In Child By Clinical Examine�
�Bp➡⬆
�Temp➡Infection
�Wt➡⬆
�Hight➡⬇
�Eye➡Cataract +Glaucoma
�What Is 3 《Major Stress
Hormons》❓��� 1�Adrenaline
2�Norepinephrine 3�Cortisol
�Pheochromocytoma� �⬆Catecholamine by tumor of
adrenal gland in chromaffin cell
�Headaches ➡ Common symptom �⬆Sweating �⬆S.Glucose
�⬆HR �⬆BP
Pheochromocytomas 7 “H”s◈
Hypertension◈Headache◈
Hypermetabolism◈Hyperhidrosis◈
Hyperglycemia◈Hypokalemia◈Hypotension [with anesthesia]
�Blood Test Of 《
Hypothyroidism》� 1◼T3 & T4
2◼⬆TSH 3◼⬆Cholesterol
4◼⬆LDH 5◼⬆Lipoprotein
6◼⬇ S.Sodium
7◼⬆Antithyroid Peroxidase ➡autoimmune
�Hyperthyroidism
Complications� �Arrhythmia
�Heart failure �Hypertension
�Opthalmopathy �Osteoporosis
�Thyrotoxic crisis� ⬆PR+⬆Temp+delirium
�What Is The Best《Initial Test
》 For Dx Of《Hyper &
Hypothyrodism》�
� TSH �
�Name The《Endocrain dz》Cause
《Clubbing Of Fingers》��
�Graves' disease �▶Thyroid acropachy
Therapeutic interventions for
thyroid storm are a
combination of antithyroid
drugs, iodine solution,
corticosteroids, β-blockers.
>: The most common cause of
drug-induced thyrotoxicosis is
amiodarone
�Give 3《Endocraine dz》
Causes 《Constipation》❔� 1◼Hypothyrodism
2◼Hyperparathyrodism 3◼Diabetes inspidus
1�Rx of DM➡Type1&someType 2
2�With glucose for Rx Of ➡Hyperkalemia
3�Rx of hyperglycemia
induce by Stress➡Surgury & infection
�What Is《Glucagon》❓� �Peptide hormone
�Produced by alpha cells of Pancreas
�⬆Glucose in blood �Act opposite insulin
️Give 4 Uses For 《
Metformin》️ 1️Type 2
DM 2️Polycystic ovary
syndrome 3️Gestational
diabetes 4️Non-alcoholic
fatty liver dz
2 important MCQ about
conn's syndrom :
_ not cause edema even
with salt and water
retention
_ cause diastolic HTN not
systolic HTN
�Give 2 Conditions
Presented With Hypertension
Pluse Hypokalemia❓�
1�Cushing syndrome 2�Connś syndrome
�Give 3《Endocrine》Causes Of
《Carpal Tunnel
Syndrome》��� 1�DM
2�Acromegaly 3�Hypothyrodism
11
�What Is Main Symptom/Signs
Of《Diabetes Insipidus》❓� �Traid Of ����
1◼Polyuria 2◼Polydipsia
3◼Dehydration
�8 Complication Of Hypercalcemia� 1�Dehydration
2�⬆BP 3�Peptic ulcer 4�Depression 5�Renal stone
6�Nephrocalcinosis 7�Pancreatitis
8�Fracture
�Milk-alkali syndrome� �High blood calcium
�Linked to
�Taking in too much calcium ➡To prevent osteoporosis
�Taking antacid contain Calcium
�7 Hypoparathyroidism Complications�
1�Tetany 2�Arrythemia 3�Short stature
4�Mental retardation 5�Seizures 6�Cataracts
7�Dental malformation
�6《Hypoparathyrodism》 Test �
1�⬇Serum Ca 2�⬆S.phosphatase
3�⬇or normal alkalin phosphate 4�⬇1,25Hydroxycholcalcifrol
5�Normal S.Mg 6�⬇PTH
�Trousseaus sign�
◼+Ve▶ before other gross
manifestations of hypocalcemia▶Tetany
◼More sensitive from▶Chvostek sign
�Cause Of SIADH 1�CNS
�Meningitis �Encephalitis
�Truma �Multipe sclerosis
2�Pulmonary �Infection �Asthma
�Lung cancers
3�Drugs ➡eg Oxytocin
�3 Important Feature In《
SIADH》� �Traid�:
1�⬆Antidiuretic hormone
2�Fluid retention ➡
Hypervolemia➡Edema 3�Dilutional hyponatremia
�Give 6 Conditions Associated
With 《SIADH》� �CNS infection
�Cerebral edema �Brain tumor �Head truma
�Lung dz �Positive pressure ventilation
�Give 4 Causes Of
《Increase ADH 》Level ❓� 1◼Truma
2◼Pain 3◼Dehydration
4◼Hemorrhge
Hypernatremia: causes6 D's: √Diuretics
√Dehydration √Diabetes insipidus √Docs (iatrogenic)
√Diarrhea √Disease: kidney, sickle cell,
ALL Endocraine dieases lead to ammorrhea Excep t
hypothyrodism = menorrhagia
Enas Enas
�Give 2 Most Important 《
Clinical Signs》 Of
《Addisonś disease》❓� 1◼⬇Blood pressure +
Orthostatic hypotension 2◼ Skin hyperpigmentation
�Dont Forget One Of
Presentation Of 《Addisonś
dz》 Is��� �Cravings For Salt Or Salty
Food�
�6 Blood Test In
《Addisonś dz》� �Eosinophilia + Lymphocytosis �Hyponatremia �Hypoglycemia �Hyperkalemia �Hypercalcemia
�Metabolic acidosis
�Give 1 《Endocraine
disease》 Cause 《Small
Heart》On CXR ❓���
� Addisonś disease �
�Give 4 Indication For Desmopresin (ADH) ❓�
1�Diabetes Inspidus 2�Hemophilia
3�Nacturnal Enuresis 4�Esophageal Varicess
�9 Pituitary Hormone��
1�Growth hormone 2�TSH 3�ACTH
4�Prolactin 5�Luteinizing hormone
6�FSH 7�Melanocyte stimulating
H 8�ADH
9�Oxytocin
12
�Adrenal Gland Hormon� �Cortex�
1■Zona glomerulosa: Aldosterone
2■Fasciculata: Cortisol
3■Reticularis: Androgen
2� Medulla� Caticholamine
الهيبر في الهرمون يعطيكل hypertension
يعطي hypothyroidism ) اال ال
hypertension )
يعطو hypo ومرضين يبدو ب ال
hypotension و hypoglycemia هما
hypoadrenalism و hypopitutarism ..
Fatma Elmarghani
وتقريبا كل أمراض االندو يديرو
proximal ms weakness وهما :
Thyrotoxicosis + cushing
syndrom + hyperaldosterolism
+ phoechromocytoma +
adrenal insufficiency +
acromegally + hypopitutarism
hypothyroidismبينما ال ال
ثالثة أمراض في األندور يديرو
osteoporosis هما :
Thyrotoxicosis +
hyperparathyroidism +cushing
syndrom )
ثالثة أمراض يديروا
hyperprolactinemia : هما
Hypothyroidism + cushing
syndrom + acromegally
Fatma Elmarghani
hoarseness ofومرضين يديرو
voice و carpal tunnel
syndrom هما :
Hypothyroidism +
acromegally
اي هرمون لما يزيد يعطي
hyperglycemia اال اإلنسولين
لما ) اإلنسولين ضد كل الهرمونات
الدم في انه ينقص مستوى السكر في
)
po4 عكس ال ca ديما مستوى ال
ض يكون مستوىاال في ثالثة أمرا
: االتنين فيهم عالي هما
( 3ry hyperparathyroidism
+ acromegaly + CRF ).. Fatma Elmarghani
RESPIRATORY
�Give 3 Important Adverse Effect Of
《Inhaler Corticosteroid�� 1●Oral candidiasis
2●Dysphonia 3●Hoarse voice
�Indications of 《Steroid》 in《
TB》���
1✳CNS TB
2✳Pericardial TB
3✳Adrenal TB
�What Is Mean By《Meigs'
Syndrome》❓��� ◼ Triad of ◼
1�Ascites 2�Pleural effusion
3�Benign ovarian tumor
�Give Infections Causes Of 《
Bronchiectasis》❓� 1�Whooping cough
2�Measles 3�TB
�《Inherited》Cause Of 《
Bronchiectasis》� 1�Cystic fibrosis 2�Kartagner dz
3�Alpha 1-antitrypsin def 4�Polycystic kidney dz
5�Immunodeficiency
�What Is Means By《Kartagener syndrome❓ �
◼Autosomal recessive dz ◼Traid � 1�Sinusitis
2�Bronchiectasis 3�Dextrocardia/situs inversus
�Give 3 Signs Of
《Sever Asthma》❓� 1�Cyanosis
2�Tripod sitting position 3�Inability to speak
�2 Indication For Repated
《CXR》 In Patient
With 《Asthma》◼ 1◼No response to Rx�
�Exclude Pneumothorax 2◼Fever�
�Exclude Pneumonia
�What Is《Drugs》Should Be
《Avoid》 In《Asthma》❓�
✔�Asprin
✔�B.blocker
✔�ACE inhibitors
13
�Give 3 Cause Of
《 Emphysema 》� 1�Tobacco smoke
2�Air pollution 3�Alpha-1-antitrypsin deficiency
�Give 2 Most Important
Presentation Of
《Alpha 1-Antitrypsin
Deficiency》�� 1�Emphysema
2�Liver cirrhosis & liver failure
�About Terms In Respiratory dz�
�Pink puffers ➡ Emphysema
�Blue bloaters ➡ Chronic bronchitis
Pneumococcal vaccination and
annual influenza vaccination
are recommended for all
patients with COPD.
Weight loss, muscle wasting,
and weakness are common in
severe COPD as a result of
deconditioning and
malnutrition.
�Give 4《Creteria》To
Dx《Cystic Fibrosis》� 1◼Recurrent chest infection
2◻Chronic diarrhea 3◼+Ve Family history
4◼+Ve Sweat test
�Give 2《Bacterial》 Causes Of
《Pneumonia》 In
《Cystic Fibrosis》❔� 1�Staph.auerus
2�Pseudomonas aeruginosa
�《Respiratory problems》 in Cystic fibrosis❓���
1�Sinusitis 2�Nasal polyp 3�Pneumonia
4�Bronchiectasis 5�Hemoptysis
6�Pulmonary hypertension
�2 Breath sound�
◼ Vesicular �Inspiratory phase>Expiratory
phas �No gap between 2 phas
◼Bronchial �Inspirat ph=Expirat ph
�Gap between 2phas
�Respiratory Failure (RF) �Type 1 RF :
�O2 tension ➡ ⬇
�Co2 tension ➡ Normal or⬇ �Type 2 RF :
�O2 tesion ➡⬇
�Co2 tension ➡⬆
�Respiratory Failure Type1
✳Cause
�Restrictive➡Pneumonia
�Obstructive➡Asthma
�Vascular➡Pulm.embolism
✳C/F �Dyspnea �Cyanosis
�Shallow breath
�Causes Of Respiratory
《Failure Type 2》� �COPD
�Impair movement of chest �Narcotic poisoning
�CVA �All causes of respiratory
�Important Feature In《
Pneumothorax》� �Acute pleuritic chest pain
�Dyspnea➡ Not improved with O2
�⬆JVP �Tracheal deviation �-Ve breath sounds
�Causes Of Pneumothorax� �Chest truma
�Ruptur air bullae
�COPD �Cystic fibrosis
�Mech ventilater �TB
�Marfan's �Ehlers–Danlos �Endometriosis
�6 Risk Factor For Nasal Polyp� 1�Chronic sinus infection
2�Asthma 3�Hay fever
4�Cystic fibrosis 5�Churg-Strauss syndrome
6�Aspirin allergy
�What is the《 Classic signs》 of
《Pulmonary embolism》 in ECG�
�S1Q3T3�
�Large S wave▶Lead I
� large Q wave▶Lead III
�Inverted T wave▶Lead III
�What Is Initial Rx Of
《TB》❓���� ◼4 - drugs ◼
1◼Isoniazid 2◼Rifampin
3◼Pyrazinamide
4◼Either▶Ethambutol or Streptomycin
�《Antituberculosis》Drugs
《Side Effect》�
�INH ➡ Peripheral neuropathy
�Rifampicin ➡ Flue like illness
�Ethambutol ➡ Optic neuritis
14
�Give 3 DDx Of《Pulmonary
Shadow》 In
《CXR》 Of《AIDS》 Pateint ❓�
1◼TB 2◼Pneumocystic carinii
3◼Kaposis sarcoma
�What Is Means By
《water-lily sign》❓ �
�Pathognomonic x-ray sign for hydatid cyst infections
�Classically seen in plain film chest x-ray
�Give 3 Common Causes Of 《
Nocturnal cough》❓��� 1◼Post-nasal drip
2◼Asthma 3◼Gastroesophageal reflux
disease [GERD]
�Give 6《Diseases》 Associated
With 《Pneumothorax》��
1✳COPD
2✳TB
3✳Cystic fibrosis
4✳Bullae on lung
5✳Sarcoidosis
6✳Marfan's syndrome
�Give 4《Causes》Of《Kussmals
Breathing》� 1�DKA
2�Chronic renal failure 3�Lactic acidosis
4�Salicylate posioning
�Name 6 Lung dz causes 《
clubbing of fingers》❓� �Lung cancer
�Interstitial lung dz
�Cystic fibriosis �Bronchioectasis
�Lung abscess �Empyema
�Treachea position ♋Normal:
�Slightly deviated to Rt ♋Pulmonary atelectasis:
�Deviated to same side ♋Pneumothorax: �Deviated to
oppsite side
�Give 3 Causes Of Cheyne_stokes Breathing ❓�
1◼Sever cardiac failure
2◼Nurological disorder ➡ Pontine haemorrhge
3◼Narcotic drugs poisoning
�Main Classification Of Pneumonia��
1◼Pathological� �Lobar
�Interstitial �Bronchopneumonia
2◼Causative agent� �Bacterial
�Viral �Mycoplasma
�Give 2 Bactreria Causes Of
《Pneumatocele》❓� �Staph aureus
�Klebsiella pneumonia �Give 7 Complication of
Mycoplasma Pneumonia❓� �Jaundice
�Myocarditis �Haemolytic anaemia
�⬇Platelet �DIC
�Stevens-Johnson sy �Meningitis
�Give 2 example of 《
Atypical Pneumonia》❓�� 1■Mycoplasma pneumonia
2■Chlamydia pneumonia
CNS
�Give 5 Important Point In Rx Meningitis ❓�
1�Antibiotics
2�Steroid➡HIb 3�Intravenous fluid
4�Treatment of complication 5�Surgury if need
�Give 2 《Risk Factors》⬆ Susceptiblity To Meningioccocal
Meningitis��
1�Deficiency in complement ➡C3,C5-C9
2�Inherited properdin deficiency
�What Is 《Classical》
《Meningeal Signs》❓� 1�Nuchal rigidity
2�Kernig's sign 3�Brudzinski's sign
�Give 2 Benifit Of 《Steroids 》
In 《Meningitis》� 1◼⬇Hearing loss
2◼⬇Rates of death in TB Meningitis
�What Is Most Common 《
Microorganism》Associated
With《Guillain-Barre
syndrome》(GBS)��� �Campylobacter�
�4 Feature In Guillain–Barré syndrome
�Ascending symmetrical paralysis
�Sensation➡Change �⬇or - Ve Tendon reflex
�Breathing muscle paralysis
15
� Symptoms Of《Parkinson's dz
》� �Traid of �
1●Tremor 2●Rigidity
3●Bradykinesia ➡ Slowness of movement
�Sign & symptom of increase ICP�
1�Headach 2�Vomiting
3�⬇Level of conciousness 4�⬇Puls rate
5�⬆Bp
6�Diplopia➡6 Cranial nerve 7�Papilloedema
� 7 《C.N.S》Causes Of 《
Vomiting》��� 1■Encephalitis
2■Meningitis 3■Migraine
4■Concussion 5■Cerebral hemorrhage
6■Brain tumor 7■Benign ⬆ICP
�DDx Of Acute Flaccid Paralysis� �Polio
�Guillain-Barre �Diphtheria
�Lyme dz �Transverse myelitis
�Myasth.gravis �Botulism
�Cord compression ◽HIV
�4《Important Feature》In 《
Poliomyelitis》��� �Asymmetrical paralysis
�> Proximally
�Deep tendon reflexes ➡Absent Or <
�Sensation ➡Not affected
�Give 2《Antibiotics》 Not Use
In 《Mysthenia Gravis》� 1�Ciprofloxacin
2�Gentamicin
�Give 5 Signs Of《Upper Motor
Nuron》Lesion�
1�Spasticity➡⬆ Tone
2�Weakness ➡Pyramidal Type 3�⬆Reflexes
4�Up-going plantar response 5�Clonus
�Give 4 Signs Of《Lower Motor
Neuron》Lesion❓� 1�⬇ Muscle tone
2�Muscles weakness &wasting
➡ Atrophy 3�Arreflexia
4�Muscle fasciculations
�Ramsay Hunt syndrome�
✳Herpes zoster infection affects The Facial nerve near ears
✳Painful shingle rash
✳Facial paralysis
✳Hearing loss
�▊Horners Syndrome▊�.
✪Sympathetic trunk damage
✪Causes→Pancoast tumore➕stroke.
️Traid� 1�Ptosis 2�Miosis
3�Anhydrosis ➡ Ipsilateral
�Give 4 Causes Of
《Miosis》�
1♏Horner's syndrome 2♏
Intracranil hemorrhage➡ Pontine hemorrhage
3♏Organophosphate poisoning
4♏Opioids posioning
�Miller Fisher syndrome��
�Variant of➡Guillain–Barré syndrome
�Cranial nerve➡Involvement �Triad of�
1�Ataxia 2�Ophthalamoplegia
3�Areflexia
�6 DDx Of Unilateral Headach�
♋Migraine
♋Cluster headach
♋Trigeminal neuralgia
♋Refer pain➡Sinus+ear+eye
♋Temporal arteritis
♋Local brain dz
�Migrain prevention�
✳Paropranol
✳NSAID
✳Ca ch blocker➡ Verapamil
✳Antidepressant➡ Fluxetine
✳Serotonin antagon➡ Cyproheptadin
✳Antiepilepsy
�HeadachType��� A�Primary⏩ 90%
1◼Migrain 2◼Tension 3◼Cluster
B�2ndry⏩ 10% 1◼Brain Infection&Tumor
2◼Giant cell artertis 3◼Glaucoma
4◼Refer H
�DDx Of Most Common
Causes Of 《Headach》 In
《Pregnancy》❓����
1◼Tension headach➡️Common one
2◼Migrain 3◼Preeclampsia 4◼Bengin⬆️ICP
�Why the《 Headach》 in
《Brain tumor 》⬆by《
Sleep》❓�� �Cerebral edema� Worsen
during sleep linked to� 1■Mild hypoventilatione
2■Lying position
16
Thiamine deficiency manifesting as Wernicke encephalopathy :● Nystagmus● Ophthalmoplegia●
Ataxia● Confusion
�Signs Of 《Cerebellar Disorder
》� �Ataxia �Intension tremor �Dysmetria �Hypotonia
�《Pupillary light reflex》� ♋2 Cranial Nerves �Optic nerve: Responsible for Afferent part
�Oculomotor nerve: Responsible for Efferent part
�What Significant Of
Examination Of《 Vital sign》 In Dignosis Of
《Cerebral edema》�� 1�Pulse Rate = Bradycardia
2�Blood presure = Hypertension
�Examination Of Patient Take Phenytoin For❓� �Gingival Hypertrophy
�Hirsutism
�Anaemia➡Megaloblastic Anaemia
�Lymphadenopathy
Causes of bilateral facial
nerve palsy:sarcoidosis,
GBS , polio, lyme disease
GIT
�Hand Examin In GIT dz�
◼Paller➡GIT Hg
◼Clubbing➡IBD+cirrhosis
◼Plumer erythemia➡Liver Cirrh
◼Flapping tremer➡Liver fail
◼Kiolonychia➡hg➡IDA
�Give 4 DDX Of
《Chronic Diarrhea》 &
《Finger Clubbing》❓� 1◼Celiac dz
2◼Cytic fibrosis 3◼Crohns dz
4◼Ulcerative colitis
�Systemic dz Causes Aphthous-Like Ulceration�
�Behçet's dz �Celiac dz
�IBD �Reactive arthritis
�Immunocompromis➡HIV �Nutritional deficiency
�Give 4《Gastrointestinal》Causes Of
《Fingers clubbing》 ❓�� 1�Celiac dz
2�Inflammatory bowel dz 3�Liver cirrhosis 4�Cystic fibrosis
�Feature Seen In Small Bowel
Biopsy Of 《Coeliac dz》� ■Atrophy of villi ■Crypt
hyperplasia ■Lymphocyte infiltration of crypts
�What Is 《Skin》 Mainfestation
Of《 Ulcerative Colitis》❓� 1�Erythema nodosum
2�Pyoderma gangrenosum
�Give 4《Endocrine 》Mainfestation Occurs In
《Liver Cirrhosis》���� 1◼Spider nevi
2◼Palmar erythema 3◼Gynecomastia 4◼Hypogonadism
�Common Causes Of《Liver
Cirrhosis》 In 《Adult》 Versus
《Children》� �Adult :
�Chronic alcoholism �Children :
�Billary atresia �Wilsonś dz
�Give 2 First Clinical Feature Seen In Celiac dz When Rx With Gluten Free diet that Indicate Improvement❓� �Improvement of mood
�⬆Appetite
�What Is The《Test》Use
For 《Monitroring》Of
Patient With《Celiac dz》On
《Gluten Free Diet》❓�
♏Anti tissue
transglutaminase♏
�Complication Celiac dz》����
1■Iron DA 2■Lactose intolerance
3■Vit. deficiency 4■Osteoporosis
5■Intestinal lymphoma 6■Neurological symptome
�Diet avoid in
《Celiac dz》❓�� �Wheat
�Rye �Barly �Oat
17
�What Is The Most Common
Cause Of 《Traveler's
Diarrhea 》❓� ◼Enterotoxigenic Escherichia coli
⭐ETEC⭐ is the most commonly Isolated pathogen
�What Is Mean By 《Parentral
Diarrhea》❓� �Diarrhea cause by disease out
side gastrointestinal tract� ■UTI
■Otitis media ■Tosilitis
■Pneumonia
�DDX of Villous Atrophy �Celiac
�Giardia �HIV �TB
�Immunodeficiency �Whipple’s
�Cows milk allergy �Tropical sprue
�Intes lymphoma �Crohn’s
�Give 4 Causes of Morning
Vomiting❓�
1✳Pregnancy
2⇑⇑✳ ICP
3✳Migraine
4✳Food Poisoning
�Causes Of《Abdominal
Distension》�
�Flatus ➡ Gas
�Faeces ➡ Constipation
�Fat ➡ Obesity
�Feotus ➡ Pregnancy
�Fluid ➡ Ascitis
�What Is Means By《Budd–
Chiari syndrome》 ❓� �Occlusion of hepatic veins that
drain liver �Triad����
1�Abdominal pain 2�Ascites
3�Hepatomegaly
�Deit avoid in
《 Wilsonś dz》❓���� �Choclate
�Nut �Shell fish
�Liver �All these high copper diet�
️Spider Nevus《Spider
Angioma》️ ️Disappears
when pressed on & comes back
when pressure releas ️Cause:
️Normal ️Pregnancy
️Hepatic dz
�What is sign of 《Ascites》on
《physical examination》❓�
1■Flank bulging▶By inspection 2■Shifting dullness
3■Fluid thril(Transmitted thril)
Disease & it is operation :
_ GERD >> _Nissan
fundiplication 360'
_ Besely 270 '
_pyloric stenosis > Ramsted
operation
_ Achalasia > Heler operation
_ plumer hydrostatic bag
�Complication Of Hepatitis B
�Hepatic failure �Chronic hepatitis
�Cirrhosis �Liver cancer
�Membranous GN �Aplastic anemia
�Cryoglobulinemia
�Which Form Of《Hepatitis
》Is The《Worst》❓� �Hepatitis( C )Infection��
1�Usually causes chronic dz 2�No vaccine
3�No cure
️Give 3 DDx Of《Tender
Enlarged Liver》❓️
️Hepatitis A ️Hepatic
abscess ️Rt side heart
failure
�Give 2 dz Associated With
《Peptic Ulcer》❓� �Zollinger-Ellison syndrome
�Crohns dz Pautz jegher disease :
Ad_mulitple_familial
Rare or no malignancy
_common affect jejenum
Juvenile polyp:
Commnest cause of
bleeding perrectum in
children
No malignant change
So if in mcQ WANT NOT
MALIGNat disease choose
jevunile polyp
FAD:
Ad _malignant _>100 polyp
�5 Complications Of Vomiting�
�Aspiration �Mallory-Weiss tear
�Dehydration & electrolyte Imbalance
�Metabolic alkalosis �Tooth enamel damage
18
RHEUMATOLOGY
�《CNS 》Mainfestation of 《
SLE》 �Mental change
�Seizure �Stroke
�Optic neuritis �Peripheral neuropathy
�Myopathy �Transverse myelitis
�Chorea
�Test To Dx《Drugs-Induced Lups
》� 1�+Ve ANA
2�+Ve Antihistone antibodies 3�-Ve Double stranded DNA
�4 Major Causes Of《Death》 In
《SLE》� 1◼Renal failure
2◼Coronary artery dz 3◼Infections
4◼CNS complications
�What Is Causes Of Anaemia In SLE��
�⬇Bone marrow activity �⬇RBC life span
�Poor iron uptake
�Drug S.E▶NSAID & steroid▶ GIT bleed
�Hemolysis
️《Drugs》 Induce 《SLE》️
1■Sulfonamide 2■Hydralazine
3■Procainamid 4■Phenytoine
�What is Investigation of《 SLE 》
& 《Neonatal Lupus》❓� �SLE⤵
1●Anti ds- DNA 2●Anti-Smith antibody
�Neonatal lupus⤵ 1●Anti Ro SSA 2●Anti Ro SSB
�Give《Sign》& 《Symptome》Of Arthritis❓�
1�Pain 2�Swelling 3�Redness 4�Stiffness
5�⬇Joint movement
�Give 7 《Viral dz 》may causes
《Arthritis》❓�� 1■Hepatitis A,B,C
2■Rubella 3■Mumps
4■Parvovirus B19 5■Varcella zoster
6■EBV 7■Coxsackie viruse
�What Means By《Reiter's
Syndrome》❓� ◼One form of reactive arthritis
◼Triad � 1�Arthritis
2�Non-gonococcal urethritis 3�Conjunctivitis
�Give Sign & Symptome Of
Arthritis❓����� 1�Pain
2�Swelling 3�Redness 4�Stiffness
5�⬇Joint movement
Gram-positive organisms are
the most common causes of
infectious arthritis, with
Staphylococcus aureus being
the most common infecting
agent
Monoarthritis differential
GHOST:
Gout �Haemarthrosis
�Osteoarthritis �Sepsis
�Trauma
�Neurological C/P In Rhumatoid Arthritis�
�Peripheral neuropathy �Mononeuritis multiplex �Carpal tunnel syndrome
�Atlanto-axial subluxation
�3《Lungs》
Mainfestations In 《
Rhumatoid Arthritis》�
1◼Lungs fibrosis➡Link to�
�Drugs ➡ Methotrexate 2◼Caplan's syndrome
3◼Pleural effusions
�5 Signs Of《
Improvement》In 《
Rheumatoid Arthritis》� �⬇Morning stiffness
�Good walk �Good hand grip �⬇Joint swelling
�Improvement ➡Hb + ESR
�Physical Examin In Rhumatoid Arthritis
�Swelling �Motion limitation
�Deformity �Stiffness
�Rhumatoid nodule �Extraarticular C/P
�Tenderness
�What Is Mean By 《
Felty's Syndrome》◼ �Traid of �
1�Rheumatoid arthritis 2�Splenomegaly
3�Neutropenia
�May associated with▶HLA-DR4
CREST syndrome:⇩⇩⇩⇩● Calcinosis● Raynaud
phenomenon● Esophageal dysmotility●
Sclerodactyly● Telangiectasia
�8 Causes Of Butterfly
19
�Goodpasture syndrome� ◼Anti-glomerular basement
antibody dz ◼Autoimmune dz
�2 Feature�� 1�Pulmonary hemorrhage
2�Glomerulonephritis
�Give 3 DDX Of 《⬇C3 》 Level ���
1�SLE 2�Post streptococcal
Glomerulonephritis 3�Bacterial endocarditis
�What Is Most Important Investigation To Measure Bone
Density In ↘
《Osteoporosis》❓� �Dual - Energy X-ray
Absorptiometry Scanning (DEXA)
Ankylosing spondylitis is
characterized by progressive
inflammatory back pain and
stiffness; onset is between 20 and
30 years of age.
HLA-B27 is the strongest genetic
risk factor for spondyloarthritis;
95% of patients with ankylosing
spondylitis are HLA-B27 positive
�Scleroderma�
�Sclero▶Hard
�Derma▶Skin �Autoimmune dz
�Normal tissues replace with dense thick scar tissue
�In child affect mostly▶Skin
�What Is�Classic Triad� Of ���
�Henoch▪Schönlein Purpura� 1◼Purpura 2◼Arthritis
3◼Abdominal pain
�5 Example Of Type III (Immune Complex) Reaction�
�SLE �Post strep Glumerulonephritis
�Rheumatoid arthritis �Scleroderma
�Sjögren's syndrom
�Give 3 dz example of 《Type II
Reactions》��� 1�Mysthenia gravis
2�Graveś dz 3�Goodpasture syndrome
D/D OF MORNING Stiffness ;
_rhumatoid arthritis
_Ankylosing spondolytis
_scleroderma
_polymylagia rheumatic
�《Action》& 2《Important Use
》Of《Allopurinol》�� �Inhibitor of the enzyme
xanthine oxidase �Use�
1�Gout and hyperuricemia 2�Tumor lysis syndrome
Rash❓� 1�SLE
2�Dermatomyositis 3�Drug photosensetivitty
4�Erysipelas 5�Pellagra 6�Rosacea
7�Scarlet fever 8�Sunburn
�Butterfly rash��
✳Seen in SLE⇒ Not Pathognomonic
✳Red&mild scal
✳On bridge of nose
✳Spares nasolabial fold
✳Macular+sharp edge
✳Not itchy
️Give 3 Causes Of 《
Charcot Joint》Or 《
Nuropathic Joint》❓️
●DM ➡ Most common
●Syphilis ➡ Tabes
dorsalis ●Leprosy
�Classification Of Lupus
Erythematosus �Four Types��
1◼Systemic 2◼Discoid
3◼Drug-induced 4◼Neonatal
RENAL
�Give 5 Complications of UTI� �Recurrent infection
�Sepsis �Urethral stricture �Kidney scarring
�In prgnancy ➡LBW & Premature labour
�2Kidneys Mainfestation In Rhumatoid Arthritis��
1�Renal amyloidosis
2�Rx with ➡
Penicillamine + Gold causes ➡ Membranous nephropathy
�Give 3《Renal Causes》
Of 《Polyuria》❓� 1●Chronic kidney dz
2●Nephrogenic diabetes insipidus
3●Fanconi's syndrome
20
�Give 3 Feature Linked To 《
Nephritic》 More Than 《
Nephrotic》❓� 1�Macroscopic haematuria
2�Hypertension 3�Raised serum creatinine
�Poststrepoccocal GN Versus
Nephrotic syndrome� �Poststrep GN�
�Edema �Hematuria
�Hypertension �Nephrotic�
�Edema �No hematuria
�Normal BP
�Post-Streptococcal Glomerulo-Nephritis�
�Proliferative GN �Type III reaction
�Hematuria➡Tea colour �Edema �Oliguria
�⬆BP �⬆ ASO titre
�⬇C3 1�TB
2�Meninigococcal meningitis
�What Is Cause Of 《Recurrent
Painless Haematuria 》That
Associated With 《Respiratory
Infections》� � IgA Nephropathy �
�4 Causes Of Anemia In《
Chronic Renal Failure》� 1�Erythropoietin deficiency
2�Hemolysis
3�Bleeding ➡Platelet dysfunction
4�Loss of appetite
�4 Feature Of 《Nephrotic
Syndrome》� 1�Proteinuria 2�Hypoalbuminemia 3�Hyperlipidaemia
4�Generalized edema ➡ Start in Face to Face
�Sign of complications in
Nephrotic sy�� ◼Abd tender⇒peritonitis
◼⇩BP⇒sepsis ◼RDS⇒pulm. emboli
◼Hematuria⇒Renal Vein Thrombosis
◼Fit⇒Stroke
�2 Types Of↙
《Albuminuria》��
�Microalbuminuria➡excretion 30 to 300 mg of albumin/24 hr
�Macroalbuminuria➡ excretion > 300 mg of
albumin/24hr
�Daily Chart For《Nephrotic
Syndrome》Pateint��
1�Wt➡Edema
2�Temp➡Infection
3�Bp➡Hypovolaemia 4�24h Urin collection
5�24h Urin albumin measure
�What Is The Most Common
Cause of 《Chronic Renal Failure
》In 《 Adult 》❓� �Diabetic nephropathy�
�Give Two 《Most common》
Causes Of 《Chronic renal
failure》 In Adult��
1�Diabetic nephropathy
➡Common 1 2�Hypertension
�Give 3《 Syndrome》
May Presented With《
Hypokalemia》 (⬇K )���
✔◼Cushing's syndrome
✔◼Connś syndrome
✔◼Bartter syndrome
� Give 6 Feature In《Sever
Hypokalaemia》��� 1�Flaccid paralysis
2�Polydepsia 3�Polyuria
4�Paralytic ileus 5�Hyporeflexia
6�Cardiac arrythemia
�Give 8 Causes Of 《
Hyperkalaemia》� 1�Addison's dz
2�Haemolysis 3�Burns 4�Diuretic
5�Crush injuries 6�Chemotherapy
7�Taking potassium 8�Tumor
�6 Medical Rx of《
hyperkalaemia》� �Insulin +Glucose
�Salbutamol inhaler �IV bicarbonate
�Kayexalate
�Loop diuretics➡Furosemide
�Hemodialysis
�Oliguria ❓ �Urine output(UOP) <
Than 1 mL/kg/h in infant (UOP) < Than 0.5 mL/kg/h
in Children (UOP) < Than 400 mL daily
in Adult
21
INFECTIOUS
�In Cholera� 1◼Factor⬆ infection :
�Type O blood group
�Lowered gastric acidity➡Antiacid drug
2◼Disease give protection : �Cystic fibrosis
�What dz Called:
《Black Death》❓� �Plague ��
�Caused by ➡ Yersinia pestis
� 2 Serious《Complication》Of
《Plasmodium
Falciparum》❓�� 1�Cerbral malaria 2�Black water fever
�Classic Signs & Symptoms Of 《
Measles》�� 1�3 C�
�Cough �Coryza
�Conjunctivitis
2�Koplik's spots ➡ Pathognomonic
�What is most common cause of
《 Death》 in
《 Brucellosis 》❓� � Endocarditis �
�Give Blood tests seen in 《
Brucellosis 》❓� �Anaemia
�Leukopenia �Elevation of AST and ALT �Positive Rose Bengal Test
�Give Other Name Of 《
Brucellosis》❓� � Malta fever �
�4 《Indications》Of《Steroid》
In 《Infectious Mononucleosis》�
1♏Airway obstruction
2♏Hemolytic anemia
3♏Thrombocytopenia
4♏CNS involvement
�What Is Serious complication of Shigellosis❓�
�Haemolytic uremic syndrome
�Give CD4 Count At Which Severe Symptoms Of
AIDS: �Toxoplasmosis of brain
�Candidiasis of esophagus �Kaposi's sarcoma❓� �CD4 count < 200/µl�
�What Is The Common Malignancy In HIV❓��
◼Children ▶ Non-Hodgkin lymphoma
◼Adult ▶ Kaposi sarcoma
�Give 4 Common (CNS)Infection In AIDS❓�
1◼Toxoplasmosis 2◼CMV
3◼Cryptococcal 4◼TB
�HIV � �Retrovirus �RNA virus
�Single strand RNA virus �Infected CD4_T cell
DERMATOLOGY
�Pityriasis rosea� ◼History of URTI
◼Single herald patch lesion (10 cm)
◼Followed in 1 to 2 weeks by ➡ChrismasTree like body rash
◼Itching
�What Is The Most Common Cause Of
《 Erythema Multiforme》❓� ◼Herpes simplex◼
�Give 4 Sexually Transmitted dz Causes
《Lymphadenopathy》�� 1�Lymphogranuloma venereum
2�Secondary syphilis 3�HIV infection
4�Hepatitis B
�Give 4 Disease Associated With ( Eczema )❓��
1�Wiskoot Aldrich syndrom 2�Lymphoma
3�Celiac dz 4�Histocytosis
�Erythema Infectioum
《Fifth dz》� �Parvovirus B19
�I.P➡4-14 days �Erythema mainly on
cheeks ➡Slapped face �Rash is pruritic
�Polyarthropathy
D/D of reccurent oral
genital ulcer;
_ Behcet ulcer (painful)
_Reiter's disease (painless)
_Syphilis (Painless)
22
�Cause Of Acanthosis Nigricance
1�Obesity 2�Malignancy 3�Type 2 DM
4�Polycystic ovary dz 5�Hypothyroidism
6�Cushingś dz 7�Acromegaly
8�Drugs
�Toxic shock syndrome� � Staph.aureus
�Associat with tampon use �Fever
�Erythematous rash �Skin desqumation
�Shock �Multiple organ failure
�What Is Means By :
《Hutchinson's Triad》� 1◼Hutchinson's teeth (Notch
Incisors) 2◼Keratitis 3◼Deafness
�Seen in ➡《Congenital
Syphilis》
�Give 4 Causes Of《Cafě aulait
Spots》� 1◼Nurofibromatosis 2◼Tuberous sclerosis
3◼Fanconi anaemia 4◼Mccune-Albright syndrome
�2《Signs》In《Psoriasis》 1�Auspitz's sign:
Pinpoint bleeding when scale remove
2�Koebner phenomenon: Psoriatic lesion induce by
skin trauma
�Give 4《Medications
Aggravate《 Psoriasis》��
1�B-blocker➡Propranolol 2�Lithium
3�Antimalaria 4�SAIDs:
ibuprofen+Naproxen
�Give 7《Causes》Of
《Hirsutism》� 1�PCOS
2�Congent. adrenal hyperplasia
3�Cushing's dz 4�Acromegaly
5�Adrenal , Ovarian tumor 6�Obesity
7�Drugs
PSYCHATRIC
�Give 5 dz Associated With
Depression❔�
1�Hypothyrodism
2�Cushings disease
3�Cancer
4�Parkinsons disease
5�HIV
There Is A Strong Relationship
Between : Stroke In Left Side
Of Brain And Depression ..
- Depression Alone : MDD
- Depression + Mania : Bipolar
Disorder Type I
- Depression + Hypomania :
Bipolar Disorder Type II
In Schizophrenia , The Most
Common Type Of Hallucination
Is : - Auditory
While In Delirium Is : - Visual
Neuroleptic Malignant
Syndrome ( NMS ) Is A
Dangerous Side Effect Of
TYPICAL Anti-Psychotic
Drugs
Classical Tetrad Of NMS : -
Mental Changes - High
Temperature - Autonomic
Instability - Muscle Regidity
Management Of MNS : -
Admission - Stop Medication -
Supportive Measures -
Dantrolene - Bromocriptine –
BDZ
Hypothyroidism
Associated With
Depression
Hyperthyroidism
Associated With Mania
Hyperparathyroidism
Associated With Anxiety
Role Of Benzodiazepine (
BDZ ) In Alcohol
Withdrawal : - To
Prevent Insomnia .. - To
Prevent Seizures ..
Benzodiazepine ( BDZ ) :
Is The Best Medication
Used In Treatment Of
Anxiety ..
23
Lithium side effects
LITHIUM:
•Leukocytes Increased
(leukocytosis)
•Tremors
•Hypothyroidism
•Increased Urine
•Moms beware (teratogenic)
Propranolol ( Inderal ) : Is Used
In Treatment Of Patient With
Akathesia ..
Clozapine : Is Used In
Treatment Of Resistant
Cases Of Schizophrenia ..
Serious Side Effect Of Clozapine Is
Agranulocytosis , So You Have To Start Gradually &
Do Routine CBC
MIXED TOPICS
Metronidazole Use� �Bactetr vaginosis
�PID �Pseudomemb colitis
�Rosacea �Intra-abdominal inf
�Amoebia �Giardia
�Trichomonus �Anaerobic bact
�Why Ciprofloxacin Avoid In
Children & Old Age❓�� �Old age > 60y ⬆ risk of�
■Tendinitis ■Tendon rupture
�Children ⬆Risk of� ■Arthropathy
�Give 3《Contraindication》For
《Gentamicin》���
✔�Myasthenia gravis
✔�Renal failure
✔�Pregnancy
�Give 6 [ Drugs ] Cause
《Gingival Hypertrophy》�� 1�Phenytoin
2�Phenobarbital 3�Lamotrigine
4�Nifedipine 5�Erythromycine
6�Cyclosporine �What is most common Micro-
organism isolated from 《Dog &
Cat bite》❓���� �Pasteurella species�
�Give 3 Conditions Have Blue Sclera❓�
1� Osteogensis Imperfecta 2� Murfan Syndrome
3� Ehler Danlos Syndrome
�Give 4 dz Cause 《Fever》 Pluse
《 Rigor》❓� 1■Malaria 2■Kala azar
3■Urinary tract infections 4■Infective endocarditis
�Eye sign in dz�
�Down▶Brushfiel spot
�Wilsonś dz▶Kayser-Fleisher rings
�Tuberous sclerosis▶Lish nodule
�Osteogenesis inperfecta▶Blue sclera
�DDx of Blue Sclerae� �Phenylketonuria �Lowe syndrom
�Types I+II osteogenesis imperfecta
�Ehler's danlos �Marfanś
�Pseudoxanthoma elasticum
�Give 3 Toxins causes 《
Hypersalivation》❓��� 1■Organophosphates
(insecticide) 2■Arsenic 3■Mercury
�Tumor Lysis Syndrome� ◼Seen 48-72 hr after
initiation of Cancer Rx�
�Hyperkalemia ➡ Early 1 �Hyperuricemia
�Hyperphosphatemia �Hypocalcemia
Causes of palmar
erythema:
1.physiological :
hyperdynamic circulation
>pregnancy<
2.pathological :
_thyrotoxicosis
_liver cirrhosis
_SLE
_R.A
_hypercapnia
�3 Causes Of Beri Beri (Vi _B1) Deficiency�
1◼Infant of mother deficient of B1 with breast
feeding 2◼Hyperemesis gravidarum
3◼Alcoholism
�Give 3 Causes Of 《
Hyperammonia》� 1◼Liver dz
2◼Lactic acidosis 3◼Reyeś syndrome
�Give 4 dz Associated
24
�Diseases More Common In �Women���
◼Thyroid dz ◼SLE
◼Osteoarthritis ◼Osteoporosis
◼Depression ◼Multiple Sclerosis
◼Migraine ◼Fibromyalgia
�Dont Forget That《Normal
Pregnancy》May Associated With ���
✔◼Aplastic anaemia
✔◼Plamer erythema
✔◼Psudotumor cereberi
�Give《 4 Infectious Diseases 》In Adult Can Treated By
《Doxycycline》❓���� 1�Cholera
2�Gonorrhea 3�Lyme dz 4�Malaria
�Give 6《Types》 Of
《Fever》: � 1�Continues 2�Remittent
3�Intermittent 4�Undulant fever 5�Relapsing fever 6�Pel-Ebstein fever
�What Is Mean By 《Female
Athlete Triad》�
1�Eating disorders ➡ ⬇Wt 2�Amenorrhoea
3�Osteoporosis➡ Stress fracture
�Risk factor for Vit K deficiency� ◼Newborn
◼Liver dz ◼Cystic fibrosis
◼Inflammatory bowel dz ◼Anticoagulant
◼Drugs �Salicylate
�Barbiturate
�Give the important
presentation of 《generalized
Tetanus》❓�
�Trismus ▶Lockjaw
�Risus sardonicus▶Facial spasm �Opisthotonos
With
《Amyloidosis》As Complication❓�
◼Rheumatoid arthritis ◼Chronic osteomyelitis
◼TB ◼Multiple myeloma
�Disease With Other Name�
◼Viscersl leishmaniasis ➡Kala azar
◼Infec mono.nucleosis➡ kissing disease
◼Black water fever ➡ falciparum malaria
�Important Note Seen In
Schistosoma Haematobium�
1■Terminal hemturia 2■Cystitis
3■Ureteritis
4■Complication▶Bladder cancer
5■Rx▶Praziquantel
�Give 3 Causes Of � Dry Mouth
&Eyes���� 1◼Sjögren syndrome
2◼DM 3◼Sarcoidosis
D. The most common cause of
drug-induced thyrotoxicosis is
amiodarone.
E. Radioactive iodine ablation is
the preferred treatment of toxic
multinodular goiter and toxic
adenoma.
F. Folate deficiency is more
common than vit B12 deficiency
in coeliac disease
B. The primary therapy for
acromegaly is transsphenoidal
surgery to remove the causative
growth hormone–secreting
pituitary adenoma.
C . The gold standard for
diagnosis of primary sclerosing
cholangitis is cholangiography.
Some important MCQS
IN medicine :
A. The classification of
type of AF (paroxysmal,
persistent, or permanent)
does not affect the
decision to anticoagulate.
25
Characterstic Drug Toxicities
Agranulocytosis Clozapine
Aplastic Anemia Chloramphenicol NSAIDs Benzene
Atropine-like Side Effects Tricyclics
Cardiotoxicity Doxorubicin Daunorubicin
Cartilage Damage in children Fluoroquinolones (Ciprofloxacin & Norfloxacin)
Cinchonism Quinidine
Coronary Steal Phenomenon Dipyridamole
Corneal micro deposits Amiodarone
Cough ACE Inhibitors
Diabetes Insipidus Lithium
Disulfiram-like effect Metronidazole Sulfonylureas (1st generation)
Extrapyramidal Side Effects Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine)
Fanconi’s Syndrome Tetracycline
Fatal Hepatotoxicity (necrosis) Valproic Acid Halothane Acetaminophen
Gingival Hyperplasia Phenytoin
Gray Baby Syndrome Chloramphenicol
Gynecomastia Cimetidine Azoles Spironolactone Digitalis Estrogen &
testosterone INH & ethionamide Clomiphine Phenytoin
Reserpine & Methyldopa
Hand Foot Syndrome 5Flurouracil (5-FU)
Hemolytic Anemia in
G6PDdeficiency
Sulfonamides Isoniazid Aspirin Ibuprofen Primaquine
Hemorrhagic Cystitis Cyclophosphamide Ifosamide (Treat by Mesna &
Acetylcysteine Bladder Wash)
Hepatitis Isoniazid
Hot Flashes, Flushing Niacin Tamoxifen Ca++ Channel Blockers
Hypertension: Postural Prazocin
Hypertension: Rebound Clonidine withdrawal
Increased intra cranial tension (
ICT)
Amiodarone Hypervitaminosis A OCP’s Tetracycline
Quinolones
Induce CP450 Barbiturates Phenytoin Carbamazepine Rifampin
Inhibit CP450 Cimetidine Erythromycin Ketoconazole
Isoniazid (INH) [remember CEKI]
Interstitial Nephritis Methicillin NSAIDs (except Aspirin) Furosemide
Sulfonamides
Milk Alkali Syndrome Calcium Carbonate (CaCo3)
26
Monday Disease Nitroglycerin Industrial exposure tolerance during week
loss of tolerance during weekend headache, tach,
dizziness upon re-exposure
Nephrotoxicity Cephaloridine Gentamycin Amphotericin
Orange Body Fluids Rifampin
Osteoporosis Heparin Corticosteroids
Pancreatitis L-Asparginase Glucocorticoids
Photosensitivity Lomefloxacin Pefloxacin
Positive Coombs’ Test Methyldopa
Pulmonary Fibrosis Bleomycin Amiodarone
Rabbit Syndrome (Perioral tremors) Phenothiazines
Red Man Syndrome Vancomycin (rapid IV)
Severe HTN with Tyramine MAOIs
SLE- Drug Induced
[Anti Histone Antibody
Characteristic of this]
Chloropromazine Hydralazine Isoniazid Methyldopa
Procainamide Quinidine [ remember CHIMP -Q]
Tardive Dyskinesia Antipsychotics (Thioridazine, Haloperidol, Chlorpromazine)
Tinnitus Aspirin Quinidine
Torsades de Pontis Terfanadine
THANX E.M.A FOR UR SUPPORT AND
GOOD LUCK
TOHAالحقوق محفوظه لصفحة تجميعات
TOHTY