Last min MRCP revision part-B
🔐 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 being reticular rash on both shuns but it us brown not red.
Pt has hypothyroid face and slow relaxing reflexes.
Rx of Churg Strauss S : steroid
if acute vasculitis of CSS : combination of steroid + cyclophosphamide
Rx of chloerstrol embolism is supportive , Dialysis if required , 1/3 pt progress to CRF
generalized systemic symptoms + peripheral neuropathy + GN + MI + Testicular pain is recognized manifestation of PAN
Diagnosis of PAN : biopsy from affected organ or demonstrating microaneurysms on angiography
Rx of PAN is steroid
DKA causes= 3Is:
Insulin ( missed)
Infection
Infarction ( MI)
DKA diagnostic criteria Joint British DM Societies 2013 GL > 11 mmol/l or pt known DM , Ph < 7.3 , HCO3 < 15 , Ketones > 3 mmol/l urine ketones :++
imp notes : SGLT2 S/E normoglycaemic ketosis
if pt T2DM wih recurrent DKA >>>> change insulin detemir (Levemir ) to insulin degludec (Trsiba)
to diagnosed diabetic autonomic neuropathy : do Isotope gastric motility study
Rx of D autonomic N : prokinetic agents such as domperidone / metoclopramide or erythromycin
to differentiate infective joints causes from Charcot's joint do : Indium - labelled white cell scan
🔴The raised Beta-D-glucan suggests a fungal cause of infection
Rx of Charcot's joint: - immobilization at least for months /bisophophonates are useful adjunct Rx
For pt with Somogyi effect do : arrange for continuous glucose monitoring
in insulin misused : low RBS / low C peptide / high insulin level
Predictor of favourable long term response to interferon
1) female gender
2)non black racial origin
3)low hepatic iron
4)absence of cirrhosis on biopsy
5) younger age
6) genotype of hepatitis c virus 2&3 better than 1 ( most important predictor)
S/E of Maraviroc (antiretroviral drug ) : depression & insomnia
Rivaroxaban is more effective in reducing mortality in pt has recurrent stroke & AF more than warfarin
Toxicology # Rx of
Methaemaglobinaemia = Methylene blue 1st line , ascorbic acid
Organopharous P = atropine , pralidoxime
Paracetamol P = N acetylcysteine , or Methionine
Cyanide P= Dicobalt ede tate , Sodium nitrite , Sodium this sulphate
B blocker = Glucagon
Rx in pregnant
Pul HTN =prostcyclin analogue
Chlamydia = Azithromycin 1 g stat (allergic to penicillin )
Gonorrhoea = ceftriaxone I. M + Azithromycin
❤ 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 being reticular rash on both shuns but it us brown not red.
Pt has hypothyroid face and slow relaxing reflexes.
Rx of Churg Strauss S : steroid
if acute vasculitis of CSS : combination of steroid + cyclophosphamide
Rx of chloerstrol embolism is supportive , Dialysis if required , 1/3 pt progress to CRF
generalized systemic symptoms + peripheral neuropathy + GN + MI + Testicular pain is recognized manifestation of PAN
Diagnosis of PAN : biopsy from affected organ or demonstrating microaneurysms on angiography
Rx of PAN is steroid
DKA causes= 3Is:
Insulin ( missed)
Infection
Infarction ( MI)
DKA diagnostic criteria Joint British DM Societies 2013 GL > 11 mmol/l or pt known DM , Ph < 7.3 , HCO3 < 15 , Ketones > 3 mmol/l urine ketones :++
imp notes : SGLT2 S/E normoglycaemic ketosis
if pt T2DM wih recurrent DKA >>>> change insulin detemir (Levemir ) to insulin degludec (Trsiba)
to diagnosed diabetic autonomic neuropathy : do Isotope gastric motility study
Rx of D autonomic N : prokinetic agents such as domperidone / metoclopramide or erythromycin
to differentiate infective joints causes from Charcot's joint do : Indium - labelled white cell scan
🔴The raised Beta-D-glucan suggests a fungal cause of infection
Rx of Charcot's joint: - immobilization at least for months /bisophophonates are useful adjunct Rx
For pt with Somogyi effect do : arrange for continuous glucose monitoring
in insulin misused : low RBS / low C peptide / high insulin level
Predictor of favourable long term response to interferon
1) female gender
2)non black racial origin
3)low hepatic iron
4)absence of cirrhosis on biopsy
5) younger age
6) genotype of hepatitis c virus 2&3 better than 1 ( most important predictor)
S/E of Maraviroc (antiretroviral drug ) : depression & insomnia
Rivaroxaban is more effective in reducing mortality in pt has recurrent stroke & AF more than warfarin
Toxicology # Rx of
Methaemaglobinaemia = Methylene blue 1st line , ascorbic acid
Organopharous P = atropine , pralidoxime
Paracetamol P = N acetylcysteine , or Methionine
Cyanide P= Dicobalt ede tate , Sodium nitrite , Sodium this sulphate
B blocker = Glucagon
Rx in pregnant
Pul HTN =prostcyclin analogue
Chlamydia = Azithromycin 1 g stat (allergic to penicillin )
Gonorrhoea = ceftriaxone I. M + Azithromycin
Comments
Post a Comment