Faraz Ahmed guide to MRCP

Asymmetrical symptoms suggests idiopathic Parkinson's Atrial fibrillation - cardioversion: amiodarone + Flecainide Atrial fibrillation: rate control - beta blockers preferable to digoxin Atrial myxoma - commonest site = left atrium Atrial natriuretic peptide - powerful vasodilator Atypical antipsychotics commonly cause weight gain Atypical lymphocytes - ?glandular fever Autosomal recessive conditions are 'metabolic' - exceptions: inherited ataxias Autosomal dominant conditions are 'structural' - exceptions: hyperlipidaemia type II, hypokalaemic periodic paralysis Avoid aspirin in children < 16 years as risk of Reye's syndrome Azathioprine - check thiopurine methyltransferase deficiency (TPMT) before treatment B-type natriuretic peptide is mainly secreted by the ventricular myocardium BNP - actions: Vasodilator diuretic and natriuretic suppresses both sympathetic tone and the renin-angiotensin-aldosterone system Bacterial vaginosis - overgrowth of predominate

Ankylosing spondylitis - x-ray findings: subchondral erosions, sclerosis and squaring of lumbar vertebrae Ankylosing spondylitis features - the 'A's Apical fibrosis Anterior uveitis  Aortic regurgitation Achilles tendonitis AV node block Amyloidosis  Anorexia features:- most things low G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia Anti-Jo-1 antibodies are more common in polymyositis than dermatomyositis Anti-cyclic citrullinated peptide antibodies are associated with rheumatoid arthritis Anti-ribonuclear protein (anti-RNP) = mixed connective tissue disease Antibiotic prophylaxis reduces mortality in cirrhotic patients with gastrointestinal bleeding Anticipation in trinucleotide repeat disorders = earlier onset in successive generations Antidiuretic hormone (ADH) - site of action = collecting ducts Antiphospholipid syndrome in pregnancy: aspirin + LMWH Antiphospholipid syndrome: (paradoxically) prolonged APTT +

H. pylori eradication: PPI + amoxicillin + clarithromycin, or PPI + metronidazole + clarithromycin  Saccharopolyspora rectivirgula causes farmer's lung, a type of EAA  ACE inhibitors have reduced efficacy in black patients and are therefore not used first-line  ADPKD type 1 = chromosome 16 = 85% of cases  ADPKD type 2 = chromosome 4 = 15% of cases  ATN or prerenal uraemia? In prerenal uraemia think of the kidneys holding on to sodium to preserve volume  Absence seizures - good prognosis: 90-95% become seizure free in adolescence  Absolute risk reduction = (Control event rate) - (Experimental event rate)  Acne rosacea treatment: mild/moderate: topical metronidazole severe/resistant: oral tetracycline Acromegaly: increased sweating is caused by sweat gland hypertrophy Activated protein C resistance (Factor V Leiden) is the most common inherited thrombophilia Acute angle closure glaucoma is associated with hypermetropia, where as primary open-angle glaucoma is associated wit

KEY POINTS FOR MRCP PART-1 AND PART 2 Wilson's disease - serum caeruloplasmin is decreased 'Fasciculations' - think motor neuron disease 1mg prednisolone = 4mg hydrocortisone 24hr oesophageal pH monitoring is gold standard investigation in GORD 4% of patients with UC have PSC, 80% of patients with PSC have UC AIP - porphobilinogen deAminase; PCT - uroporphyrinogen deCarboxylase Chorea is caused by damage to the basal ganglia, in particular the Caudate nucleus Drusen = Dry macular degeneration D ystrophia myotonica - D M1:- D istal weakness initially autosomal D ominant         D iabetes D ysarthria  Streptococcus bovis endocarditis is associated with colorectal cancer  Streptococcus pneumoniae is associated with cold sores  E. coli is the most common cause of travellers' diarrhoea  H. pylori eradication: PPI + amoxicillin + clarithromycin, or PPI + metronidazole + clarithromycin  Saccharopolyspora rectivirgula causes farmer's lung, a type of E

In Gout : # Raburicase is recombinant urate oxidase preferable in Rx of gout induced by chemotherapy for haematological malignancies. # Lesinurad is  - is an OAT-1 Inhibitor which drives high urate excretion. - it can be used in combination with xanthine oxidase inhibitor. - effective for long term  gout management ; it can drive plasma urate down towards the normal range  🔴remember Ivabradine is CI in AF  indications of digoxin: 1.AF in sedentary pt. sp. if there is heart failure 2. peripartum cardiomypathy. Rx for ABPA: 1st line... steroids.. if not effective or can't take due SE...then itraconazole Rx for Aspirgilloma: 1st line... Long term oral itraconazole; if not effective or tolerate then do surgery Pt of Aspirgilloma with haemptosis...1st line or do immediately angiography and emobilization...then after lobar resection Rx for invasive aspergillosis: 1st line... iv Voriconazole then orally for 10days..if not effective or tolerate then liposom

MRCP Last min Revision digoxin can be used to control the heart rate in AF when the patient is sedentary or there is coexisting heart failure  Rx * Ankylosing S    : TNF a / Adalimumab * Abatacept is CTLA-4 IG interfere with T cell use in Rx of RA * Tocilizumab is anti IL6 monoclonal AB used for RA * Trastuzumab use in breast cancer S/E Cardiomyopathy so it's needs regular monitoring of EF [11/06, 1:40 a.m.] ....: Sacubitril valsartan  is dual action , combining ARB +Neprilysin inhibitor >>> It reduces both mortality & admission for heart failure by 20% What's Fifth disease ?? Fifth disease is viral illness that most kids recover from quickly and without complications. Also called erythema infectiosum, it's caused by parvovirus B19. It's especially common in kids ages 5 to 15. Fifth disease causes a distinctive red rash on the face that makes a child appear to have a "slapped cheek." * pt with resistant HTN with hypokalaemia

MRCP last min Revision notes Lsteriosis = Amoxicillin Genital herps ulcer (recurrent but healed ) : Acyclovir 400 mg tid till 36 weeks If not healed ulcer acyclovir till delivery To  D b/w membranous GN from chronic  tubulo-interstitial GN in pt take chronic NSAIDS by proteinuria marked in MGN SeHCAT test : investigation for bile acid Malabsoption / diarrhea  Drugs causing lung fibrosis amiodarone cytotoxic agents: busulphan, bleomycin anti-rheumatoid drugs: methotrexate, sulfasalazine, gold nitrofurantoin ergot-derived dopamine receptor agonists (bromocriptine, cabergoline, pergolide) Pyrazinamide Should NOT be used in pts with known chronic liver dx...🚫 Rx of CF▶exocrine pancreatic supplements+ fat-soluble vitamins...  Rx of systemic sclerosis associated lung fibrosis ➡high dose oral corticosteroids + cyclophosphamide. Tense blistering itchy rash in apt with NSTEMI▶Bullous pimphigoid caused by Furosemide 😵  Ludwig's angina Rx▶iv antibiotics ag

🔐 the last revision :  ❤ in MRCP - apparent mineralocorticoid excess: hypokalaemia with HTN >> Glycyrrhizic acid poisoning  component of natural liquorice block activity of 11 B hydroysteroid dehydrogenase Pt with acute exacerbated COPD + Af = check s K COPD distressed not responded for max Rx with respiratory acidosis but still conscious >>> Rx by NIV Haemophilus influenzae ass with exacerbation of COPD  causes of levido reticularis 1.cherg-strauss syndrome 2. antiphospholipd syndrome 3. cholest erol embolism 4. erythema ab agine 5. polyartritis nodosa (PAN) 6.SLE 7. Amantadine. (other S.E atbaxia, slurred speech, confusion, dizziness ) 8. May be seen in homocyctinuria ( increased incedence of thromboembolic phenomena ttt pyrodoxin and folic acid churg dtrsuss and cholestrol embolism both ass with eosinophelia moreover, warfarin can precipitate cholesterol emboli ----------------- Peritibial myxoedema is similar to levido reticularis in bein

🔐 the last revision :  ❤ in MRCP 2 : ECG : ♠Lead Reversal : changes mostly  in P & T  wave : inversion Lt arm / Lt leg 👉 changes in lead 111 Lt arm / Rt arm 👉  lead 1 avL /avR 👉 both lead 1& 2 ♠ PE : S1 Q3 T3 ♠ Brugada Syndrome  : Pseudo RBBB + downsloping  ST elevation ♠ Acute pericarditis 👉Coxsackie group B virus ♠ CHB post stenining do temporal pacemaker 🔍🔎  One Modern anticholinergic for  Rx of urge urine incontinence is Solifenacin , traditional Rx such as Oxybutynin S/E  affect in cognition .... If Rx failure ▶ sacral nerve stimulation 🔍🔎 modern RX FOR HCV :Sofosbuvir MOA NS5B RNA polymerase inhibitor, Alendronate is contraindicated if GFR less than 35  Teriparatide is a synthetic PTH analogue,  use in severe cases of osteoporotic,  with caution  as it associated  moderate to worse renal impairment BTX reaction related to immunoglobulins deficiencies think in selective IgA def IgM associated with increase risk of G-ve pul infection

NEUROLOGY Horner's syndrome - anhydrosis determines site of lesion:  head, arm, trunk = central lesion: stroke, syringomyelia  just face = pre-ganglionic lesion: Pancoast's, cervical rib  absent = post-ganglionic lesion: carotid artery Hypertension should not be treated in the initial period following a stroke Kearns-Sayre syndrome  mitochondrial inheritance  onset < 20-years-old  external ophthalmoplegia  retinitis pigmentosa Lateral medullary syndrome - PICA lesion - cerebellar signs, contralateral sensory loss & ipsilateral Horner's Loss of corneal reflex - think acoustic neuroma Medication overuse headache  simple analgesia + triptans: stop abruptly  opioid analgesia: withdraw gradually Migraine  acute: triptan + NSAID or triptan + paracetamol  prophylaxis: topiramate or propranolol Miller Fisher syndrome - areflexia, ataxia, ophthalmoplegia Motor neuron disease - riluzole Motor neuron disease - treatment: NIV is better than rilu