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- &macro-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