Sanjay Sharma Summary of Difficult Topics

7/26/2019 Sanjay Sharma Summary of Difficult Topics

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Sanjay Sharma : Summary of difficult topics fro Sharma MRCP Part2

(By Dr Sujit Vasanth)

1. (8) RUQ pain, fever, jaundice -- ascendin! ch"#an!itis. can "ccur even after

ch"#ecsytect"$y. %nv. ""d cu#tures ('.c"#i), US t" ec#ude a&scess. #iver &i"sy sh"u#dnever &e 1st test f"r jaundice and fever.*. (1+) isti"cyt"sis $anifestati"ns are due t" histi"cyt"$as *-/ yrs, 0. #un! fi&r"sis

and 234D, &"ne infi#trati"n (esp s5u##), pr"pt"sis, deafness, hepat"sp#en"$e!a##y,#y$phaden"pathy, dia&etes insipidus (pituitry infi#trati"n). D &y hist"#"!y (s$a## r"und

ce##s). R ster"ids, "ccasi"na##y vincritine. "ccasi"na# sp"ntane"us re!ressi"n.

6. (1*) f#"7 v"#u$e #""p UR "&structi"n decreased inspirat"ry f#"7.

/. (1*, 69) #euc"errythr"astic ""d fi#$ i$$sture !ranu#"cytes, n"r$"asts 2auses$arr"7 infi#trati"n (inc#udin! $sre &"ne d, $ye#"sc#er"sis, st"ra!e diseases #i5e :ucher;s

- #ar!e 7hite fi##ed ce##s), severe infecti"n (#eau5ae$"id d"h#e &"dies, t"ic !ranu#ati"ns).

Differentiaite &y presence "f hepat"sp#en"$e!a##y "r #y$haden"pathy and a&sense "f #eft

shift). p"sitive !ra$ stain. (it 7ent 4"sitive#y 4urp#e 7ith p#easure). 4in5 >ne!ative. :42"cci>StrepStaph. :ndip#"c"cci>=eisseria, :=r"ds>ae$"phi#us. B>G= red.

16. (61) precipitants "f 3=H A S su!ary drin5s, infecti"n, thiaEides, ster"ids, 0%. %f

hypernatrae$ic use +./ #in5ed, *. fe$a#e t"

$a#efe$a#e "n#y then $it"ch"ndria#.


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Su#phasa#asine R esp if :?4D deficiency. 2f "7e## L"##y &"dies, cf. 0a#aria ""d fi#$s

(can &e c"nfused)

*@. (@/) Cpica# #un! fu&r"sis B, 'CC, an5y#"sin! sp"ndy#itis, aper!i##"sis, radiati"n,sarc"id"sis, hist"icyt"sis .

*8. (@?) a$i#ia# &eni!n hyp"ca#ciuruc hyperca#cae$ia A aut d"$. Usua##y #ife#"n!

asy$pt"$atic hyperca#cae$ia "ccasi"na# !a## st"nespancreatitisj"int dep"siti"n. Difficu#tt" distin!uish &et7een 1ry 4is$ s" patients "ften have uneccesary parathyr"idect"$yand parathyr"idect$y. 2an dist!iuish &ecause urinary ca#ciu$ is 3J (it is hi!h in a##

"ther causes "f hyperca#cae$ia). 2"nservative $ana!e$ent.*9. (@@) 'ruptive anth"$as thin5 hypertri!#yceridae$ia (ass"ciated 7ith pancreaitis).

here is pseud"hyp"natrea$ia due t" #ipids &indin! =a A the free s"diu$ "n#y is n"r$a##y

$easured. 2an differentiate &y #""5in! at seru$ "s$"#a#ity.

6+. (8/) J"#f 4ar5ins"n Jhite syndr"$e access"ry fast c"nductin! atri"ventricu#arpath7ay (Bund#e "f Hent). Ventric#es dep"#arise pre$ature#y -- sh"rt 4R, s#urred (de#ta

7ave) upstr"5e "f QRS. * arryth$ias p"ssie CV re-entrant tachycardia (4 &urried C'R

QRS R. Va!a# sti$, aden"sine) , C (de#ta 7aves s"$eti$es seen R aden"sine, va!a# sti$

usua##y fai#s). *nd #ine -- cardi"versi"n. Definitive $ana!e$ent radi"freFuesncy aati"n.4reventi"n 7ith c#ass %%%%

(s"ta#"#, f#ecainide, a$i"dar"ne, dis"pyra$ide). Cv"id di!"in and verapa$i# as they increaseaccess"ry path7ay c"nducti"n predisp"sin! t" $a#i!nant ventricu#ar arryth$ias.

61. (8@) 4"#ycythe$ia ru&ra vera A & can &e n"r$a# if c"eistin! e deficiency anae$ia (#"7

02V), #""5 at 42V and r&c c"unt t" $a5e the dia!n"sis. C## $arr"7 ce##s increased (7cc, p#t)

and sp#en"$e!a##y.%ncidi"us "nset ass"c #ethar!y, depressi"n, verti!", tinnitus, a$aur"sis fu!a. 4#eth"ra,

hypertensi"n, spen"$e!a##y. B#eddin! (usua##y upper :%) due t" thr"&"cythae$ia, str"5e

(hypervisc"city), !"ut (increased ce## tun"ver). 2an pr"!ress t" $ye#"fi&r"sis "r C0. R.

Venesecti"n (can cause fe def anae$ia). Busuphan and hydr"yurea t" c"ntr"#

thr"$&"cyt"sis.6*. (91) yp"5a#ae$ic peri"dic para#ysis A aut d"$, epis"dic para#ysis c#assica##y 7hi#epatient as#eep "r 7ith pr"#"n!ed rest. 4pt &y detr"se and insu#in, a#c"h"#, ch", aniety,

tensi"n. R can !ive H supp#e$ents "r #"n!eter$ H sparin! duiretics. Css"ciated 7ith

"rienta#s 7ith thyr"t"ic"sis. yp"5a#ae$ic arryth$ias. R "f thyr"t"ic"sis prevents

para#ysis t"", pr"pran"#"# a#s" 7"r5s. 3n#y affects $a#es. =eed t" ec#ude :BS "r$yasthenia !ravis.

66. (9/) Sch$idtE syndr"$e (p"#yend"crine deficiency type %%) A 1+I "f addis"ns pients

have "ther end"crine a&n"r$ai#ies t"" - aut"i$$une hyp"thyr"idis$ and %DD0. ype % 4'D

> parathyr"id, adrena#, candida, a#"pecia, pernic"us anae$ia. Viti#i!" and hyp"!"nadis$ "ccurin &"th. yp"thyr"idis$ can cuase a #ar!e heart.

6/. (9@) epr"spir"sis (rat faeces) A #iver fai#ure c"$$"n, rena# fai#ure can a#s" "ccur.Bruce##"sis (unpasteurised c"7s $i#5) A #iver fai#ure rare, ass"c hepat"sp#en"$e!a##y, hi!h

fever and #euc"penia.

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6@. (1+1) %V infecti"ns "ra# hairy #euc"p#a5ia (>'B2 infecti"n) - 7hite p#aFues "n the

#atera# &"rder "f t"n!ue R. Ccyc#"vir cf candida r. =ystatin, f#ucanaE"#e.

2ryp"t"sp"ridiu$ diarr"hea A G= stain "f st""# -- red cysts. R. Sy$pt"$tic spira$ycinpar"$"$ycin.

68. (1+6) S' A arthr"pathy, fever, p"#yser"sitis. 1+10, ac5s, usu##y M/+yrs. 0u#tisyste$

inv"#ve$ent rena#, resp, 2VS, neur", hae$at"#"!ic, cutane"us. DsD=C p"sitive in ?+I, C=Cin 9+I. 'SR usua##y hi!h, 2R4 characteristica##y n"r$a#. 26 depressed. upus antic"a!u#ant.R. =SC%Ds (j"ints), ch#"r"Fuine (s5in), c"rticster"ids, aEathi"prine, cyc#"ph"spha$ide.

69. (1+6) c"sac5ie virus CB - epide$ic $ya#!ia (B"rh"#$;s syndr"$e) usua##ychi#dreny"un! adu#ys. Sudden a&d"th"racic pain. 0ya#!ia, fever. 4"#yser"sitis. Virus in

faeces, retr"spective dia!n"sis &y seru$ anti&"dy / rise.

/+. (1+@) :ui##ain Barre syndr"$e A "nset "ften hera#ded &y S'V'R' #u$&ar "r intrascapu#ar

pain. Cns neur"pathy e.!. B#adder at"ny. 2sf A a#&u$in"cyt"!enic diss"ciati"n. R. %v %!. 4""rpr"!nstic $ar5ers V2M1#itre, pa3* M8, pac"*?, R%, p"#$ "ede$a, acce#erated

hypertensi"n, arryth$ia, &u#&ar inv"#ve$ent, ca$py#"&acter infecti"n.

/1. (11+) "$"cytinuria A cystathi"nine deficiency, aut recessive, chr *1--- h"$"cysteine

accu$u#ati"n-- "idised t" h"$"cystine (e#evated urine #eve#s). 2ystine =3 pr"duced.Defects in c"##a!en cr"ss#in5in!. 0arfan"id features (ta##, arachn"dacty#y, hi!h arched

pa#ate, #ens dis#"cati"n), "ste"per"sis, epi#epsy$enta# hadicap, ven"usarteria# thr"$&"sis(324 c"ntraindicated), f"#ate deficiency (inc 02V), pre$ature c"r"nary art disease. R.

Restrict $ethi"nine, add cystine. :ive 4yrid"ine as s""n as dia!n"sis is $ade.

/*. (11*) hyp"tensi"n, hyper5a#ae$ia, $eta&"#ic acid"sis -- Cddis"ns, diureticssa#t #""sin!

nephritis./6. (11/) hyp"5a#ae$ia -- !i "r rena# #"ss. R'=C if 1. N4'R'=S%V' 7ith hi!h renin

($a#i!nant hypertensi"n, RCS, diuretics), 7ith #"7 renin (c"nn;s, cushin!;s, #idd#e;s>tu&u#ar

defect $i$ics c"nn;s &i"che$istry) *. C2%D3%2 thin5 RC as $"st "ther causes !ive

a#5a#"sis. 6. =3R03'=S%V' diuretics, car&en""#e, #iFuerish, a$in"!#yc"sides,

Barters>chi#d L:C hyperp#aia, 7ea5ness, n"cturia, fai#ure t" thrive. #iFu"rish andcar&en"a#"ne can a#s" cause hypertensi"n. %=H 3 :CSR3 2CUS'S % H %S CV%DNR'C%='D R30 H%D='N ie. M*+ 0003 UR%=CRN H.

//. (11


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7asted #"7er #i$&s -- inverted cha$pa!ne &"tt#e #e!s, f""t def"r$ity,sc"#i"sis, sens"ry

ataia. d , nerve c"nducti"n, chr 1F. S0=* $i#der. S0=6 ( Dejerine S"ttas d) aut

rec. $ied neur"pathy. presents M1+yrs 7ith pa#pae periphera# nerves (pa#pe nerves a#s"seen in acr"$e!a##y, #epr"sy, nft, hiv)

/@. (1*+) 0ethae$"!#"&inae$ia (i.e. ae$ e*--e6) ass"c 7ith :?4D (#"7 =CD4 s" &

$"re readi#y "idatised). 0et& hi!h afinity 3*-- " diss curve #eft shift-- dec tissue"y!enati"n. variae de!ree "f cyan"sis. $et& #eve# *+I (dyspn"ea, headache, an!ina)?+I c"##apse, sudden death. B#""d fi#$ intravascu#ar hae$"#ysis, einE &"dies. 2auses

:?4D, dru!s (su#ph"na$ide, pri$aFuin, phenacetin), t"ins (ferric cyanide, ch#"rate, ani#inedyes)

/8. (1*+) #eft shift "f 3* diss"ciati"n curve $et&, su#ph&, 23&, eta#&, decreased

*6B4:, a#5a#"sis, hyp"capnia, hyp"ther$ia.

/9 (1*1) pain re#ief and rena# fai#ure -- thin5 aute interstitia# nephritis $"st #i5e#y.


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?+. (16?) C$pheta$ines can induce c"r"nary vas"spas$, ventricu#ar arrhyth$ia,

$y"carditis, t"rsaeds (they pr"#"n! Q) e.!. c"caine i a y"un! ath#ete -- 0%, n"r$a#

an!i"!ra$. Beta"c#ers c"ntraindicated &ecause un"pp"sed a#pha sti$u#ati"n ina$pheta$ine a&users causes severe hypertensi"n. C$#"dipineverapa$i# sh"u#d &e used.

h"c$ is the c"$$"nest cause "f death in y"un! ath#etes.

?1. (168) 2"n!enita# Cdrena# yperp#asia aut recessive. *13 deficiency c"$$"nest. 6path7ays ch"#ester"# can $a5e pr"!ester"ne, a#d"ster"nc"rtis"# ("c5ed), test"ster"ne.resu#ts in hi!h test"ster"ne (viru#isati"n, hersuitis$ 0 pr"c pu&erty) and pr"!ester"ne

(a$enn"rria), #"7 adrena# h"r$"nes (hyp"tensi"n, v"$itin!, fai#ure t" thrive). i!h C2, 1@3 pri!ester"ne, hi!h urinary 5et"ster"ids (e.! pre!nanetri"#), #"7 c"rtis"#. R

hydr"c"rtis"ne c"rrects deficiency and supresses andr"!en pr"ducti"n *. f#udr"c"rtis"ne as

necessary. Synacthen test is a&n"r$a# cf. 423S.

?*. (1/+) "icara infecti"n, d"!.cat reserv"ire, faec"ra# spread, * syndr"$es viscera#$i!rans syndr"$ (#"ca# e"sin"phi# e"sin"phi# rich !ranu#"$as, f#u #i5e sy$pt"$s, rec"very *-6

7ee5s, R. thia&endaE"#e"r diethy#car&aEine), "cu#ar t"cicariasis (indness, r"und s7e##in!

near "ptic dis5, %!0 a&s t" ""cara in aFue"us "r vitre"us hu$ur R #aser ph"t"ca#!u#ati"n

- adjunctive str"ids.?6. (1//) C$"e&ic #iver a&scess. RV'D4 and atria# pressures are eFua#. (restritive cardi"$y"pathy - 7hich is patchy,V'D4RV'D4, usua##y tricuspid r $itra# re!ur!)

?@. (1/9) %V r 2D/M


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@1. (1


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Pictures to know:

1.einE &"dies (denatured & seen in hae$"#ysis)

*.ived" reticu#aris6.y$ph"erythr"astic &"ne $arr"7

/.retinitis pi!$ent"sa


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Sanjay Sharma Summary of Difficult Topics

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