Last min MRCP revision part-B

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🔐 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
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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

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