Faraz Pearls For MRCP

FARAZ’S PEARLS
FOR MRCP
➡ Chapter wise POINTS for part-i & part-ii

➡ points taken from past papers ,onexam,passmedicine ,passtest EDITION 1st
➡includes scenarios ,investigations, treatments
➡single source to pass both parts of MRCP VOLUME - I
➡ALL 14 chapters points are added
➡Past papers pointes are added in separate section
➡main points are highlighted BY:DR FARAZ AHMED
➡Valid for all exams of MEDICINE ( IMM,FCPS PART-II) MRCP (UK) PART-I &
➡SINGLE read takes less than A week
PART-II 1
Faraz’s
Pearls for MRCP
VOLUME-I
First edition
By: Dr Faraz Ahmed

MBBS SMBBMU larkana (Pakistan)
MRCP(part-I,II) United kingdom
2
Faraz’s
Pearls for MRCP
MRCP (UK)
Copyright ©2019
All rights reserved

No part of this application may be reproduced, printed or transmitted in any for or by any means,
Electronics of mechanical, including photocopying ,recording or any information storage or retrieval
System without permission in writing from the publisher.
3
SUCCESS IS NO ACCIDENT.
It is hard work, perseverance ,learning ,studying ,sacrifice and most of all ,Love of
what you are doing.
DEDICATION
This book is dedicated to my father who always taught me to love giving & helping
others. Had it not been him I would have not been what I am today.
And to my dear colleagues ,wishing that this book could help and ease their approach
in exam both part-I and part-II.
Special Thanks to
Dr SADAM H. BHUTTO (MRCS UK)
Dr ABDUL FATAH TUNIO 4
Contents
1. Information regarding MRCP examination.
i. How to prepare for MRCP part-I …………………………………………………8
ii. How to prepare for MRCP part-II………………………………………………….12
2. NEUROLOGY…………………………………………………………...17
3.PULMONARY ……………………………………………………………30
4.GIT+HEPATOLOGY…………………………………………………..44
5.CARDIOLOGY ……………………………………………………………56
6.NEPHROLOGY …………………………………………………………………….65
5
Contents
7.HAEMATOLOGY ………………………………………………………74
8.ENDOCRINOLOGY……………………………………………………84
9.RHEUMATOLOGY…………………………………………………….96
10.INFECTIOUS DISEASE ……………………………………………108
11.DERMATOLOGY………………………………………………………118
12.PHARMACOLOGY &TOXICOLOGY………………………..130
13.PSYCHITARY …………………………………………………………….146
6
Contents
14.ONCOLOGY……………………………………………………………..157
15.OPTHALMOLOGY…………………………………………………..169
16.CLINICAL SCIENCE…………………………………………………181
17.PAST PAPERS……………………………………………………………209
18.QUESTIONS DISTURBATION PART-I…………………….219
19.QUESTIONS DISTURBATION PART-II……………………221
20 .HOW TO ATTEMPT PAPER …………………………………..223
7
HOw TO prEpArE fOr pArT-I
Duration required = if you are non traniee-4.5 month minimum
 Hours of daily study if you are non trainee is - 8 hours for 1st 3 months,
 9 hours for last 1.5 month.
 If you are trainee - 6 Months minimum
 4 hours daily for 1st 3 months, 5 hours daily for next 2 Months and in last Month 6 hours daily.
Sources: theory books :
 Notes & Notes
 Step up to Mrcp by Khaled El Magraby
 Faraz’s pearls for MRCP
Chapters to be read from notes &notes rest from Khaled
 1.Clinical science
 2.pharmacology
 3.Nephrology
 4.Cardiology
 5.GIT+HEPATOLOGY
8
Q banks:
 Pass medicine (most important q bank)
 Pass test
 On examination
Cover following chapters from on examination
 1.nephrology
 2.blood oncology
 3.clincal science
 4.infectious disease
 Rest from pass test
9
 Past papers: read recent papers at least of 8 years ,read
them after your 1st read of q banks.
 Faraz’s pearls for MRCP: Read Faraz's pearls in last 25 days

of your preparation at least twice ,one read will take minimum
of 12 days.
Sample papers : solve sample paper before 10 days of your

exam and solve your weakness in last days specially the topics
in which you perform poor in sample paper...
10
What you should not do?
 1.skiping past papers
 2.leaving sample paper for last 5 days
 3.reading lengthy books
 4.not reading said theory books
 5.making day off from studies
 6.overuse of face book
 7.not taking participation in whatsapp discussion
11
How to prepare for MrCp
part-II
Duration required : if your score is very high
in part-I then 5 month is enough,
if your score is low in part -I then 6-8 month...
Sources: Theory books:
what ever theory books you read in part I .
Faraz’s pearls for Mrcp (very much important
during last of your exam ).
12
Q banks :
Pass medicine :read at least 1.5 times
Pass test :read it once
On examination :read only those chapters in
which you are weak
Faraz’s pearls read it twice ,it will cover all your q
banks and past papers
13
 Past papers :
 Solve at least previous eight years past papers
 Images :
 Radiology =Your Q banks and Google is enough
search every picture from Google.
 Dermatology =DermNEt NZ website, Google Q
banks.
 Rheumatology : use Google and q banks
 Echo :Google, data interpretation by Philip hughes
and sanjay Sharma (read sanjay Sharma first to
understand about Echo )
 Respiratory volume loops questions :sanjay
Sharma and data interpretation by Philip hughes .
14
ECG :
do Hampton 150 cases and LITFL ECG library
website
Data interpretation by Philip Hughes:
Solve each chapter data questions from this
book.
Faraz’s Mrcp visuals :
This book has all images collected ,u can skip
above image books if u read only this.
15
Sample paper :
Solve 10 days before your exam,this will tell you
whether u pass or not.
 Cover topics which feel you are weak in last 10 days .
 Remember success comes to those who work hard for it,sit it
in chair stop your breadth ,life after your success is beautiful
and loving.
 good luck 
16
Neurology pearls
NEUROLOGY PEARLS
 1.Best parameter to monitor in GBS is =Forced vital
capacity
 2. Young patient +Cerebellar
hemgioblastomas+polychethemia+kidney cyst + renal
cell carcinoma is =von hippel landau syndrome
 3. Middle aged lady+ personality changes + sexual
habits + inappropriate in social situations + repeatedly
asking same questions+=picks disease
 4. 1st line treatment to prevent vision loss in idiopathic
intracranial hypertension is=urgent LP shunt
17
 5. Sensor neural deafness + absent corneal reflex
absent + facial nerve palsy =Acoustic neuroma
NEUROLOGY PEARLS
 6.Young patient + ipsilateral headache +
ipsilateral Horner syndrome + contralateral
hemiparesis +neck pain =Carotid artery dissection
 7. 1st line drug in status epileptics is
=Benzodiazepines IV Lorazapam
 8. Patient on neuroleptic treatment +visual
hallucinations +features of Parkinson +dementia
less than 1 year is = lewy body dementia
18
 9. History of migraine with Aura +stroke +positive family
history of migraine and early dementia is=CADASIL
(cerebral autosomal dominant arteriopathy with
NEUROLOGY PEARLS
subcortical infract and encephalopathy)
 10. Visual hallucinations in clear conscious + visual field
defect + MME score for dementia is normal + history of
glaucoma or cataract is =Charles Bonnet syndrome
 11. Deafness + pulsatile tinnitus + cranial nerve IX,X1+
pulsatile reddish blue mass in tympanic membrane
=Glomus jugulare tumour.
 12. 1st line drug treatment in neuroleptic malignant
syndrome is = Bromocriptine
 13. Young patient +pain after excessive exercise +Dark
urine /tea coloured urine is = McArdle disease Do muscle
biopsy
19
14. Young patient +lancinating pain in extremities
after vigorous exercise +stroke + angiokartomas
periumblicaly is = Fabry's disease
NEUROLOGY PEARLS
 15. Young patient + opthalmoplegia+ ptosis
+Retinitis pigmentosa (RP) +cerebral syndrome
+cardiac conduction defect + hearing loss is=Kearns
Sayre syndrome
 16. Iv drug use + descending progressive weakness
+Cranial nerve involvement affecting ocular movement
+ swallowing facial musculature +autonomic features
+loss of reflexes is= Botulism
 17. Optic neuritis + myelitis + vomiting + Aquaporin 4
antibody+ MRI spinal cord lesson extend over 3
vertebral segment = Neuromyelitis optical/ Devic's
disease
20
 18. . 30 to 50 years + chorea(piano playing)+ personality
changes + unsteady gait + dementia + saccadic eye
NEUROLOGY PEARLS
movement + lack of coordination + caudate nucleus
atrophy putamen atrophy =Huntington disease
 treatment with tetrabenazine
 19. History of viral infection + recurrent vertigo +
nausea , vomiting + horizontal nystagmus + no hearing
or tinnitus is= Vestibular neuronitis
 20. Investigation of choice to diagnose Carotid dissection
is =Ct Carotid angiogram
 21. Distal weakness + common peroneal palsy +ulnar
nerve palsy + pescavus + clawed toes+ areflexia+
kyphosis is= Charcot Marie tooth disease
21
 22. Yoga exercise +neck pain + occipital headache + numbness of
face + loss of pain and temperature ipsilateral + nausea ,vomiting
vertigo +nystagmus is =Vertebral artery dissection
 diagnostic test is =MRA brain
NEUROLOGY PEARLS
 23. Peripheral neuropathy + sensorneural deafness +anosmia
+cerebral ataxia + pes cavus+ night blindness+ cardiomyopathy +
retinitis pigmentosa + short 4th and 5th toe +high phytic acid is =
Refsum's disease
 24. Multiple nerves involvement + conduction blocks +
fasciculation + sensory exam normal + reflexes normal +anti GM1
antibodies high =Multifocal motor neuropathy treat with
immunoglobulin's
 25. Headache ,vomiting +local infection sinusitis + perioribital
oedema + opthalmoplegia 6th CN+ 3rd and 4th nerve + 5 CN
hyperaesthesia if upper face and eye pain is=Cavernous sinus
thrombosis
22
 26. Lower limb is more involve than upper limb
contralateral hemiparesis =Anterior cerebral stroke
 27. Upper limb \face more involve than lower limbs
NEUROLOGY PEARLS
contralateral hemiparesis =middle cerebral artery stroke
 28.Agitation+hallucinations+delusion+seizures+dyskinesia
+ovarian tumours + MRI normal or showing deep
subcortical limbic structures =Ct scan of abdomen pelvis
confirms ovarian carcinoma + antiNMDA antibodies
is=Anti NMDA rec encephalitis give iv steroids and
immunosuppression
 29. After Ct scan confirm nontruamatic SAH next step is to
confirm It by Urgent angiography thru Ct scan or MRI
before endovascular clipping or coiling
 30. Seizures + behaviour changes like patient accuses her
wife of having affair with pm + headache + oral facial
dyskinesia + insomnia is= Autoimmune limbic encephalitis
23
 31. Cancer patient /chronic immunodefient state/ immunosuppressive
drugs +personality changes +intellectual impairment + focal
neurological signs + cortical blindness + seizures + coma + csf normal +
MRI non enhancing white matter lesions + jc virus is=Progressive multi
NEUROLOGY PEARLS
focal leucoencephlopathy
 32 . Most accurate test for myasthenia gravis is=Single fibre
electromyography
 33. Moderate sized haematoma in basal ganglia with minimal mass
effects next step is=Admission to stroke unit or observation
 34. L4 =i) anteromedial part of shine ii) knee reflex hip adduction
,knee extension, ankle dorsiflexion and foot inversion
 L5=hip extension, knee flexion, ankle dorsiflexion, big toe extension
 S1=sole of foot, ankle reflex ,hip extension, ankle plantar flexion and
foot eversion
 35. Radiotherapy more than chemotherapy in neurooncology
 36. Smacking his lips and spontaneous recover +remain unaware of
episode +as child had history of febrile convulsion ,is=complex partial
seizure
24
 37. déjà vu + epigastric sensation fallowed by loss of consciousness + lip
smacking + history of febrile convulsion is =temporal lobe epilepsy do
MRI
 38. Short stereotyped events + abrupt onset termination + bizarre
NEUROLOGY PEARLS
voculations + nocturnal nature of events is = Frontal lobe seizures
 39. Opthalmoplegia +disturbance of consciousness + ataxia +
hyperreflexia + antiGqIb + history upper tract infection is=Bicker's staff
brain stem encephalitis
 40. Young women + dilated pupil one is larger than other + absent
ankle/knee reflex + mostly unilateral + slow reactive to near
accommodation reflex is =Holmes Adie pupil
 41. Dix Hall pike manoeuvre help in diagnose of benign positional
vertigo ,Epley manoeuvre treat benign positional vertigo.
 42. Sudden loss of vision + optic nerve swollen + retinal haemorrhages
in all quadrants + affarent pupillary defect is=CRVO treat with steroids
or antiplatelet
 43. Investigation of choice for CRVO is =Fluorescein angiography
25
 44. HIV patient + neck stiffness + photophobia + mild raise csf protein
,decreased csf glucose ,lymphocytic pleocytosis+MRI ventricular
enlargement with ependymal enhancement +gradual memory loss is=
NEUROLOGY PEARLS
Cmv meningoencephalitis
 45. Chinese /Japanese + stenous exercise + meal rich in carbohydrates
+ heaviness in limbs + palpitations + tendon reflexes hypoactive,
plantar mute =thyrotoxicosis hypokalemic periodic paralysis
 46. Patient already on antiepileptic sodium valproate then continue at
low dose and give folic acid and do scan at 12 week
 47. Loss of fingers touch, vibration,proproception on ipsilateral side +
hyperreflexia, extensor plantar on ipsilateral side + segmental
anaesthesia at level of lesson loss of pain and temperature on
contralateral side is =Brown sequard syndrome
 48. Alien limb i.e. limb arm moves on it's own + sensory loss +
supranuclear gaze palsy + non fluent aphasia + adult onset Parkinson
disease is= corticobasal degeneration
 49. Investigation for CADSIL is =Notch 3 genetic testing
26
50.Nystagmus+ophthalmoplegia+ataxia+alchlocs+
confusion + peripheral sensory neuropathy decrease red
cell transketolase is = Wernicke's encephalopathy
NEUROLOGY PEARLS
Treatment = give thiamine
51. Unilateral complete Ptosis + Normal/ Mydriasis ---
3rd nerve Palsy
Unilateral partial Ptosis + MIOSIS--- Horner Bilateral
Ptosis + NO Opthalmoplegia--- Myotonic dystrophy
Bilateral Ptosis + Opthalmoplegia--- Myasthenia Gravis
52.vesticular schwanoma has unilateral symptoms unlike
Minners disease which is bilateral
27
 53.Buttock and thigh claudication + normal straight leg
raise + pain relieved by rest is = lumbar Spinal stenosis
 Investigations are : MRI shows loss of epidural fat on
NEUROLOGY PEARLS
T1 weighted images loss if csf signal around Dural sac
and degerntivr disc disease
 Treatment : DE compressive lumbar laminectomy first
line surgical intervention.
 54.Normal straight leg raise in spinal stenosis
differentiate it from other causes of lower limb nerve
pain.
 55.In prolapsed lumbar disc there is pain on straight
leg raise
28
 56.HTN + localized cerebellar signs = Cerebellar
haemorrhages
 57.In MS if significant residual volume = self Catherization
NEUROLOGY PEARLS
. If no significant {anticholinergic oxybutynin imipramine
 58.Botuslism in urge incontinence
 Pelvic floor exercise for stress incontinence.
 59.L2 = hip flexion
 L3=knee extension
 L4=ankle dorsi flexion
 L5=great toe extension
 S1=ankle plantar flexion
 S2=knee flexion
 60.Lesion in ventral pons leads to locked in syndrome
include tetra paresis with loss of lower cranial nerve
resulting in bilateral facial nerve palsy and dysphagia.
29
respIratory pearls
RESPIRATORY PEARLSPEARLS
 1.Gold standard diagnostic test for Obstructive sleep
apnoea = Polysomnography
 2 .Yellow discoloration of nails + lymphedema +pleural
effusion + bronchiectasis is = yellow nail syndrome
 3.Obese man + tired all time day time somnolence +
apnoea at night reduced REM sleep + snoring +
Hypertension + retained C02 is=obstructive sleep apnoea
syndrome (sleep apnoea/hypopnoea
 4. HRCT is investigation of choice in idiopathic pulmonary
fibrosis showing honey combing
 5. Pulmonary function in obesity
 Restrictive
 No effect on KCO
30
 6. Findings of obstructive pattern:
 FEV1 significantly reduced less 70%FVC reduced or normal FEV1/FVC =reduced
less than 80% or 0.7Raised total lung capacity Raised residual Volume
 7. Findings of restrictive pattern:FEV1 reduced less than 80%FVC =significantly
reduced FEV1/FVC =normal or increased more than 80%Lung compliance , TLC
RV are decreased
 8. Causes of obstructive pattern :
 COPD
 Asthma
 Bronchiectasis
 Bronchiolitis obliterans
 9.Causes of restrictive pattern
 Idiopathic pulmonary fibrosis
 Pulmonary haemorrhages
 Asbestosis
 Sarcodosis
 ARDS
 Extrinsic allergic alevolitis
 Histocytosis Coal worker's pneumococcal
 Polio
 Myasthenia Obesity
 Scoliosis 31
 10. Causes of increased TLCO :
 Most obstructive has low TLCO except Asthma
 Pulmonary haemorrhages ( Wagner's, good pasture) Left to right shunt
Polchythemia Exercise
 Male Hyperkinetic state
 11. Causes of Low TLCO:
 All restrictive gives low TLCO except pulmonary haemorrhages)
 Pulmonary fibrosis Pulmonary emboli
 Emphysema Pulmonary oedema
 Anaemia Low CO
 Pneumonia
 Sarcodosis
 12. Pulmonary function in obesity
 Restrictive
 No effect on KCO
 13.Causes of high KCO with normal or low TLCO
 Lobectomy / pneumoectomy
 Neuromuscular weakness Scoliosis/kyphosis
 Ankylosing spondylitis
32
 14. KCO reduced in
 interstitial lung disease
 Restrictive disease
 Pulmonary embolism
 Vasculitis
 15,KCO increased in:
 Haemorrhage Polchythemia
 16. Young patient with DM + recurrent chest infections + Diarrhoea +
abnormal LFTs + gallstones + steatorrhoea + constipation is = Cystic fibrosis
 17. Features of cystic fibrosis
 Delayed puberty Short stature
 Pancreatic polyps
 Diabetes Miletus
 Rectal prolapse
 Male infertility (due to Mal development of vas deferens
 Female subinferlity
 Meconium ileus
 18.Oragnisms in Cystic fibrosis patients Infants and young children =
Staphylococcus aureus, Haemophilus
 Teenagers = Pseudomonas aeruginosa treated by inhaled tobramycin
Aspergilus Burkholderia cepacia
 Mycobacterium tuberculosis 33
 19.Teenger with Cystic fibrosis presents with chest infection treated
with ceftazidime + tobramycin
 20.Rapidly progressive fever + high volume of purulent sputum
uncontrolled bronchopneumonia weight loss septicaemia by
Burkholderia cepacia treated by Ceftazidime+aminoglycosides
 21.Lab of cystic fibrosis :
 Sweat test :sweat chloride more than 60mmol/L
 Decreased chloride secretion
 increased sodium absorption
 CFTR gene Genetic test is confirmatory F508(DF508)mutation on
chromosome 7
 22.Treatment of cystic fibrosis :
 Chest physiotherapy postural drainage
 High calorie + high fat Vitamin D
 Pancreatic enzymes
 Supplement N- Acetylcystein
 Heart lung transplant
 Gene therapy Human Recombinant DNASE
34
 23.CT scan of Chest is diagnostic for pancoast tumour.
 24.Diagnostic investigation of choice for sarcodosis is = Trans
bronchial lung biopsy
 25.Mangement of obstructive sleep apnoea is :
 Weight loss
 CPAP is first line for moderate and severe OSA
 Intraoral devices ( Mandibular advancement )
 If CPAP is not tolerated Uvulopalatophrngraphy
 Tracheostomy is last resort.
 26.Epworth sleepiness in obstructive sleep apnoea is:
 Mild = 4-14
 Moderate=15-30
 Severe = more than 30
 Mild is treated by weight loss
 Moderate and severe is treated by = CPAP
35
 27.Survival benefits in stable COPD patients are :
 Smoking cessation
 LTOT
 Lung volume reduction surgery
 Steriods reduced exacerbation frequency but not the mortality
 28.peripheral edema + raised JVP +SYSTOLIC Parasternal heave + loud p2 +
COPD is =. Cor pulmonale
 Treatment is = loop diuretics for oedema
 LTOT
 ACEI ,CCBs ,Alpha blockers are not recommended.
 29. Indications of LTOT are :
 pO2 of < 7.3 kPa (55 mmhg) or to those with a pO2 of 7.3 - 8 kPa( 60mmhg )
and one
of the following:
secondary polycythaemia
nocturnal hypoxemia
peripheral oedema (cor pulmonale )
pulmonary hypertension
 At least 15 hours a day.
 30. Patients who are critically ill (anaphylaxis is ,shock) oxygen should be at
15 /min.
36
 31.carbon monoxide transfer factor shows prognosis in = idiopathic
pulmonary fibrosis .
 32. 50-70 years + exceptional dyspnoea + bilateral fine basal crackles +
clubbing + dry cough + restrictive spirometry is = Idiopathic pulmonary
fibrosis .
 33.indications of lung volume reduction surgery :
 1. CO2 retention 7.3 cut of
 2.severe limitation of exercise
 3. upper lobe emphysema
 34. Treatment of idiopathic pulmonary fibrosis :
 Prednisolone 0.5 mg
 LTOT
 Lung transplantation .
 Pulmonary rehabilitation
 Pirfenidone ( antifibrotic agent )
 Interforne gamma 1 beta and bosentan
 Nintendanb.
37
• 35. if PH is less than 7.25 = give invasive ventilation.
• 36. NIV complication = pneumothorax
• 37.Treatment of exacerbation of COPD :
• Increase frequency of bronchodilator give via nebulizer
• Prednisolone 30mg for 7-14 days.
• 38.History of tuberculosis / cystic fibrosis + haemoptysis +
cough + chest round opacity surrounded by rim of air +
serum increase titre Aspergilus precipitants ( IgG
antibodies ) is = Aspergiloma .
• 39. Treatment of Aspergiloma .
• Surgical resection
• Long term itraconazole if not fit for surgery.
• Life threatening haemoptysis=after transfusion and
resuscitation angiography and arterial embolization after
that lobar resection as intervention of last resort 38
 40.Asbestosis occur in Plumber , boiler , shipyard , pipe occur after 15-30 years causes
lower lobe fibrosis Plural plaques are benign calcification in hemidiaphrgm.
 41.Bilteral infiltrates (hazy showading) in Chest X-ray + P02/Fi02 less than 200 + Low PCWP
less than 18 + burn history is =ARDS
 42.Causes of ARDs Infections :
 Sepsis.
 pneumonia,
 Tuberculosis ,
 uraemia
 anaphylaxis
 Burns
 Pancreatitis
 Trauma
 43.Massive blood transfusion Smoke inhalation injury Cardiopulmonary bypass.
 44.Pcwp in ARDs is less than 18mmhg while in Cardiogenic pulmonary edema it's more
than 18.
 45.Treatment of ARDS
 Mechanical ventilation with maximal ventilatory therapy Fi02 100% PEEP 15cmH20 peak
pressure 40cmH20
 If still unresponsive(on maximum ventilatory therapy and still hypoxia) Extracorporeal
oxygenation (ECMO)
39
 46. Progressive breathlessness + large amount of sputum (bronchorrhoea)+ alveolar
walls filled with mucin is = bronchoalveolar cell carcinoma
 47.Dyspnoea + fatigue, weakness, syncope + left parasternal heave + loud P2 +
pansysytolic from TR + early diastolic murmur is = Pulmonary arterial hypertension
 48.Drugs associated with pulmonary arterial hypertension is appetite suppressants,
amphetamine.
 49.. With GCS less than 8 and patient suffering from unprotected airway = intubation
fast bleep ETT and give high flow oxygen if he is not chronic co2 retainer.
 50. Acute exacerbation
 pneumonia
 Lung fibrosis,
 pulmonary embolism
 Causes of type2 respiratory failure are :
 COPD,
 acute severe asthma,
 Ankylosing spondylitis,
 Kyphoscoliosis
 Treatment of type1 :High conc Oxygen(>35% usually 60%high flow 6-8L
 Treatment of type2:Low conc(24-28%)Low flow (1-2L/min)
40
51.Type1 respiratory failure = Pao2=less than 8
PaC02 =less than 6.6
Type2 respiratory failure = Pa02<8PaC02=>6.6
(hypercapnia)
52.Causes of type 1 respiratory failure are :
acute Asthma,
emphysema,
 COPD + respiratory type 2 is treated by NIV if
there is no contraindication to it if there is
contraindications then use intubation
ventilation.
41
 53.Punemonia + high WBC + high inflammatory markers + unilateral
consolidation + pigeons is = Chlamydia psittaci pneumonia
 Treatment: tetracycline or macrolides
 54.Shortness of breath + dry cough + fever + bilateral basal inspiratory
crackles + upper lobe fibrosis + IgG precipitins is= Extrinsic allergic
alevolitis
 55.Lab in extrinsic allergic alevolitis (hypersensitivity pneumonitis) :
 Chest X –RAY : upper lobe fibrosis
 BAL : lymphocytosis
 Blood : NO Eosinophilia IgG precipitants
 Saccharopolyspora in farmers lung No high IgE
 No positive skin test
 No antibiotic
 Remember in hypersensitivity pneumonitis there is bilateral findings
on x-ray
 56.Treatment of extrinsic allergic alevolitis Antigen avoidance Oral
steroids
42
 57. Pigeons bird fanciers :avian proteins
 Farmers lung : Saccharopolyspora rectivirguls
 Malt workers lung: Aspergilus clavatus
 Mushroom workers lung: thermophilic actinomyces
 Bysinosis :textile industrial cotton hemp dust
 Baggassosis: sugarcane
 58.Spirometry in extrinsic allergic alevolitis is mixed.
 59.Techypnae+techycardia+Low grade fever + sudden onset chest pain +
haemoptysis + normal chest x-ray is = Pulmonary embolism.
 60.Lab in pulmonary embolism:
 PE likely >4 points = Do CTPA if there is delay give LMWHPE
 unlikely≤4 or less consider D dimer if positive then do CTPA
 CTPA is contraindicated in renal impairment and contrast allergy use v/Q scan
 ECG:S1Q3T3,RBBB,right axis deviation ,sinus tachycardia
 V/Q mismatch: pulmonary embolism , AV malformation, Vasculitis ,COPD gives
matched defect
 Pulmonary angiography gold standard but complication
43
gastroeNterology &
GASTROENTEROLOGY PEARLS
Hepatology pearls
• 1.Truma / violet vomiting / endoscopic procedure/
malignancy + shock + pain + left side pleural effusion +
pleural Fluid Exudative and high amylase + ratio of
pleural fluid amylase to serum amylase >1 is =
Oesophageal rupture
• Diagnosis : radio logically with water soluble contrast
Treatment : Surgical
• 2.Gastroenteritis : Empirical antibiotic only indicated if
systemically unwell , immunosuppresion,or elderly
even if patient has bloody Diarrhoea so give oral
rehydration solution otherwise
44
 3.Patient taken metronidazole for 7 days for Clostridium
diffcle he improved no symptoms but yet stool shows c.diffcle
next step = Nothing needed
 4.Investigation of choice for barret oesophagus is =
Endoscopic biopsy.
 5.Management of barret oesophagus is :
 No dysplasia + <3 cm of barret = endoscopy every 3 to 5 years
with biopsies
 No dysplasia+>3cm =endoscopy every 2 to 3 years + start PPI
and repeat endoscopy and biopsy every 2 .
 grade dysplasia = High dose PPI +every six monthly biopsy.
 High grade dysplasia = oesophagectomy + photodynamic
therapy and ablative therapy.
 6.Isolated unconjugated hyperbilirubmina + normal LFTS is =
Gilbert syndrome
 7.Jaundice in Gilbert is exacerbated by : fasting,alchol,acute
illness even like sore throat also by ostrogen improved by low
dose barbiturates
45
 8.Risk factors for barret oesophagus are :
 Gerd
 Male Stricture or ulcer Has increased risk of adenocarcinoma
 Metaplasia of lower oesophagus when normal squamous epithelium
replaced by columnar epithelium
 9.Investigations in Gilbert syndrome are:
 Rise in bilirubin provoked by prolonged fasting or IV nicotinic acid.
 10.Management of Gilbert syndrome is :
 No treatment required
 If severe jaundice = Phenobarbitone
 11.Non bloody Diarrhoea + young patient + weight loss + abdominal
mass palpable on right iliac fossa is = Crohn's disease.
 12.Complications of Crohn's diseases are :
 Gallstones oxalate
 renal stones
 Fistula
 Anal tags
 Mouth ulcers
 Perianal disease
 Episelritis 46
 13.Lab in Crohn's disease are:
 Histology : all layers trans mural ,High goblet cells ,Granulomas
Endoscopy : deep ulcer, skip lesion , cobblestone
 Radiology : stricture : Kantor's string sign ,rose thorn ulcers, fistula,
proximal bowel dilation
 ASCA +P-ANCA –
 14.Smoking worsen Crohn's but improves ulcerative colitis .
 15.Management of Crohn's diseases:
 Inducing remission : steroids (oral, rectal ,IV) Azathioprine or 6
meracaptopurine add on Methotrexate alternative to azathioprine
(Contraindicated in anaemia )
 2nd line is steroids but not as affective as azathioprine is 5ASA(
mesalazine ) Refractory Crohn's = infliximab IV Fistulating Crohn's =
Infliximab
 Perianal disease = Metronidazole
 Diet in Crohn's : short term TPN,enteral feeding elementary diet low
fat medium chain TGA in diet Lactose intolerance dairy free diet.
 16.Crohn's disease in pregnancy is = steroids
47
 17.Maintaining remission in Crohn's disease :
 No steroids
 Stop smoking
 Azathioprine or meracaptopurine is 1st line
 Methotrexate 2nd line 5-ASA drugs(Mesalazine) if surgery has done.
 18.Complications of surgery in Crohn's disease:
 1.bile salt Malabsorptive =bile acid diarrhoea with abnormal 14C glucolate test
treatment : Cholestrayamine
 2.Cholesterol gall bladder stones
 3.urinary Cal oxalate stones and renal calculus treatment : good hydration,
dietary oxalate restriction (cocoa, peanut tea coffee wheat germ rhubarb
spinach ,Cholestrayamine
 4.pyoderma gangreosum.
 19.Crohn's disease + surgery ileostomy +deep ulcer begin to form skin round
stoma = pyoderma gangreosum treatment oral steroids.
 20.Depression+ sertraline use + Lymphocytes infiltration is =
 Lymphocytic colitis treatment is withdrawal of drug
 Loperamide,Cholestryamine,Azthioprine.
48
 21.Young patient +bloody Diarrhoea + abdominal pain on left lower quadrant
is = ulcerative colitis
 22 Investigation in ulcerative colitis :
 Crypt abscess
 Depletion of goblet cells
 No Granulomas
 Endoscopy : pseudo polyps
 Radiology: loss of haustrations Colon narrow and short drainpipe colon
 P-ANCA + ASCA –
 23.Most common site of ulcerative colitis = rectum
 Most common site of Crohn's diseases=terminal ileum.
 24.Management of ulcerative colitis : Inducing remission: rectal topical
5ASA,oral ASA
 2nd line = oral steroids
 Servere colitis = IV steroids
 Maintaining remission in ulcerative colitis
 Oral 5ASA :
 Mesalazine
 Azathioprine or meracaptopurine
 No Methotrexate here
 25.Colorectal cancer UC > Crohn's
49
 26.Mild to moderate Ulcerative colitis = sulphasalzine
 Severe UC =IV steroids.
 27.Side effects of sulphasalzine are :
 Skin rashes
 Oligospermia
 Headache
 Heinz bodies
 Agranulocytosis
 Pancytopenia
 Stomatitis
 Parotitis
 28.Side effects of Mesalazine are :
 GI upset
 Headache
 Agranulocytosis
 Pancreatitis
 Intestinal nephritis
 29.Oligospermia by sulphasalzine
 Pancreatitis with Mesalazine >sulphasalzine
 30.Investigation in IBD are :
 Endoscopy is investigation of choice = ileocolonscopy
 C -reactive shows disease activity
 High faecal Cal protectin high in IBD (50)Normal faecal calprotecin make it less likely
50
 31.With use of infliximab and azathioprine care of non
melanoma skin cancer should be kept in mind.
 32.Crohn's like enterocolitis = Mycophenolate mofetil.
 33.Air bubbles on passing urine = Crohn's with colovesical and
fistula.
 34.Ulcerative colitis : Mild :<4 stools per day, small blood in
stool, no temperature ,pulse 90 hb : 9 anaemia, ESR 30 CRP:30
 Moderate:4-6 stool per day, blood in stool mild to severe ,no
temperature, pulse 90,no anaemia ESR 30,CRP 30
 Severe:>6 stool per day , visible blood,37.8 C temperature
pulse>90 anaemia <105g ESR>30 CRP>30
 35.Most reliable sign in toxic megacolon = pulse rate.
 36.Helpful investigation in toxic megacolon = X- ray
 37.Treatment of choice in toxic megacolon = Colectomy
 38.Best investigation in toxic megacolon is = Flexible
sigmidoscopy
51
 39.Investigation contraindicated in toxic megacolon are :
 Barium enema
 Colonoscopy
 40.Criteria for toxic megacolon :
 >6 stools bloody per day
 >37.8 C
 HR>90
 TLC neutrophils
 >10Hb <10.5
 ESR=>30
 CRP >30
 Dilated colon 6m
 X-ray loss of haustrations and mucosal oedema thumb printing
 42.Management of toxic megacolon :
 HDU + high dose IV steroids + rectal steroids + IV fluid + LMWH + cyclosporine
(+infliximab + surgery + no antibiotic
 43.Treatment in Toxic megacolon :
 1st IV steroids then Colectomy + cyclosporine if contraindicated then Infliximab
 44.Toxic megacolon seen in : Ulcerative colitis mainly Pseudomembranous colitis,
Ischemic colitis 52
 45.Precipating factors for toxic megacolon are :
 Low K
 Low Mg
 Under treatment
 Nsaids
 Opioids
 Bowel perforation
 Antidiarrheal
 46.Total Colectomy in UC+ high stool + urgency + incontinence + nocturnal sleepage is = pouchitis
following ileal anal anastomosis
 treatment : antibiotics metronidazole ciprofloxacin.
 47.UC ≤ colorectal cancer :
 Low risk : <5 years colonoscopy means extensive colitis but no active Endo/histology exam ,left
sided colitis
 Intermediate:3year Colonoscopy : extensive colitis with mild to active Endo histology exam, post
inflammation polyps or family history in 1st degree 50or over
 High risk:1year follow up extensive colitis with moderate or severe Endo histology Stricture
Dysplasia
 48.40-60 years + weight loss +Diarrhoea+ seronegative arthropathy + stoarrhaoe + abdominal
distension + seizures + myoclonus + ataxia + Endocarditis + oculomastictory myoarthytitis +
Valvular conduction problems + anaemia + pleurisy is = Whipple disease by tropheryma Whipple
53
 49.Investigation in Whipple disease are :
 Duodenal ,junjunal biopsy showing t.whipple with in PAS stain
 PCR DNA best diagnostic to detect remission after prolonged therapy
 50. treatment of Whipple disease :
 Initial :IV penicillin and streptomycin for 2 weeks followed by one year
 of tetracycline and cotrimazole Cerebral involvement doesn't treated
 by antibiotics
 51.Diabetes mellitus + hypogondasim loss of libido + bronze skin
pigmentation + arthralgia pseudo gout chondrocalnosis + erectile
dysfunction + heart failure + Hepatocellular carcinoma is=Hereditary
hemochromatosis
 52.Reversible complications of hereditary hemochromatosis are:
 Cardiomyopathy
 Skin pigmentation
 Hepatosplenomegaly and high liver enzymes.
 53.Irreversible complications of hereditary hemochromatosis are :
 Arthropathy
 Diabetes mellitus
 Liver cirrhosis
 Hypogondasim
54
 54.Investigation in Hereditary hemochromatosis are :
 General population: Transferrin saturation >ferritin Family
members:
 HFE genetic testing chromosome 6.
 55.Liver biopsy gold standard in Hereditary hemochromatosis.
 56.If transferrin saturation >45% warrants further testing
 if <45% exclude dx If ferritin >1000 =liver biopsy.
 57.Typical iron study in hemochromatosis:
 High iron >30Low TIBC <20High ferritin >500Transferrin
saturation>55% in men >50%in women.
 58.Treatment of hereditary hemochromatosis :
 Repeated venesection most cheapest effective treatment
 Iron chelation with desferioximine
 if venesection Liver transplantation
 59.Upper GI endoscopy is useful for gastric cancer.
 60.Liver biopsy is gold standard for hemochromatosis
55
CarDIology pearls
 1. Stopping smoking has greatest benefit in reducing
CARDIOLOGY PEARLS
cardiovascular risk factors
 2. ECG in ASD is
 Ostium scandium = RBBB +Right axis deviation
 Ostium premium =RBBB +Left axis deviation
 3.. Pressure difference in aorta and left ventricle is = Aortic
stenosis
 4.Myocardial infraction + low blood pressure + systolic
dysfunction + cardiomegaly + upper lobe diversion is =
Cardiogenic shock
 Treatment is diuretics and inotropes ,intra aortic balloon
pump
 5.Complete heart block from inferior myocardial
infraction does not need pacing unlike CHB from anterior MI
56
 6. 1 to 6 weeks after myocardial infraction + fever + pleurtic
chest pain + pericardial effusion + friction rub + raised ESR is
=Dresser syndrome
 Treatment is aspirin Nasid ,If still resistant steroids
CARDIOLOGY PEARLS
 7. PCI is gold standard treatment in St elevation mi with 12hrs
 8. Blood pressure controlled by ACEi has greatest effect on
myocardial infraction.
 9. High pressure in left ventricle + steep drop off between LV
and Aortic pressure is =HOCM
 10.. High pressure in left Atrium + normal pressure in left
ventricle is =Mitral stenosis
 11. High pressure in right ventricle +normal in pulmonary
artery is =Pulmonary stenosis
 12. Difference gradient of pressure between left ventricle and
aortic pressure LV - Aortic pressure is = Aortic stenosis
 13. Cause of AS Younger patient less than 65years = bicuspid
aortic valve Older patients more than 65years= calcification
57
 14. Features of severe AS
 Narrow pulse pressure
 Slow raising pulse
 Delayed ESM radiating to Carotid
 Soft or absent S2
CARDIOLOGY PEARLS
 S4Thrill
 Duration of murmur
 15.Treatment of AS if asymptomatic = Observe
 symptomatic =Valve replacement
 If asymptomatic but gradient more than 50 and features of LV dysfunction is = Surgery
Before valve replacement do coronary angiography t o rule out coronary a disease,
Transcather aortic valve implantation if previous dement inoperable due to comardites
 Pregnancy with symptoms = Porcine valve replacement
 16. Drugs decreasing incidence of coronary events are:
 Antiplatelet
 Beta blockers
 ACEi
 Gemfibrozil
 17. Worst prognosis of carcinoid syndrome is = Valvular heart disease
 18.. Right heart failure + Ascites + pericardial calcification on x-ray +x and y descent +
kausmual breathing is = constrictive pericarditis
 Treatment is with antiTB, Steriods if not then pericardectomy
58
 19. Normal response of exercise tolerance is =increase in BP and
increase in Pulse
 20. Treatment of SVT
 Vagal manoeuvres ,Carotid sinus massage contraindicated in carotid
vascular disease IV adenosine 6 mg then 12mg contraindicated in
CARDIOLOGY PEARLS
Asthma use verapamil
 21. SVT + asthma = give verapamil
 22.Preganacy + SVT = Adenosine
 Prophylaxis = beta blockers and verapamil avoid BETA BLOCKERS in 1st
trimester
 23.Streptococcal bovis + infective endocarditis do= Colonoscopy
 24.Post valve surgery less than 2month common cause of infective
endocarditis is = staphy epidermis Post valve surgery more than 2
month cause of infective endocarditis is = Staphylococcus areaus
 25.I/V drug user cause of infective endocarditis = Staphylococcus
areaus
 26.In dental procedure most common cause of infective endocarditis is
= Strep Virdnas
 27. Bowel resection common cause of endocarditis is = Bacteriods
59
 28.Useful lab test monitor treatment of Infective endocarditis is =C reactive
protein
 29. ECG of LVH =R wave in V5 or V6 plus S wave in V1 or V2 exceeds 35mm
 30.1st line treatment in chronic heart failure is =ACEI and BB
 2nd line =Aldosterone antagonist ,ARB , hydralazine nitrates.
CARDIOLOGY PEARLS
 31.Drugs improve mortality Heart failure are:
 ACEi ,
 Beta blockers,
 Spironolactone ,
 Hydralazine with nitrates
 32.Indications of IvAbradine:
 Ejection fraction less than 35%
 When medical therapy has failed
 HR more than 75 NYHP class 2
 33. Indications of cardiac resynchronization in Heart failure are :
 QRS more than 150ms with LBBB
 Ejection fraction less than 35
 NYHP class 3,4
 34.Indications of ICD
 QRS 120-149 but no LBBB
 Ejection fraction less than 35 symptomatic heart failure .
60
 35. Indications of anticoagulant in Heart failure:
 Previous thromboembolic event.
 Intrathoracic cardiac thrombus
CARDIOLOGY PEARLS
 Left ventricular aneurysm
 36.INR more than 8 +no bleeding /minor bleeding =stop Warfarin +give
Vitamin K 2.5 to 5mg Give warfarin once INR is less than 5
 INR 5-8+no bleeding =stop warfarin
 INR 5-8+minor bleeding=stop Warfarin +give Vitamin K 1-2.5mg and
restart warfarin once INR is less than 5
 37.Treatment of heart blocks 1st degree =no treatment
 2nd degree type 1 mobitz wenckenbach = asymptomatic Discharge
With symptoms=permanent pacemaker Type 2= transvaneous cardiac
pacing
 Complete heart block=permanent pacemaker Temporary transvaneous
pacing
 38.Atropine is not useful in type 2 block and complete heart block
61
 39.1st degree block= prolong PR more than 0.2
 2nd degree type 1=progressive prolongation if PR interval until
dropped beat
CARDIOLOGY PEARLS
 Type 2=PR interval constant but P is not fallowed by QRS
 Complete heart block=no association between P wave and QRS
 40.Patient having chest pain exercise but not on rest next step
= do coronary angiography
 41. Holter mentoring is used for rhythm disorder
 42. Stress exercise tolerance are used when aetiology is not
clear and ECG is not diagnostic
 43.If you can't read ECG in stress test then use thallium scan or
Echo detection of wall motion
 44.If patient can't exercise then use Dipyridamole with
thallium scan it Dobutamine with ECHO
 45.3 vessel disease or 2 vessel disease in diabetes needs CABG
1 or 2 vessel disease needs stent placement
62
 46.Arterial fibrillation + Valvular disease is = Give Warfarin
 47.Arterial fibrillation + Stroke or TIA = Give warfarin
 48.. Arterial fibrillation + CHADS score zero = No treatment
 49.Pharmacological cardio version If no structural heart disease = Flecainde
CARDIOLOGY PEARLS
 If structural heart diseases = Amiodarone
 50.Factors favouring heart rate control in Arterial fibrillation:
 i. older than 65 years
 ii. History of ischemic heart diseases
 51.Factors favouring rhythm control in Arterial fibrillation :
 i. younger than 65 years
 ii. symptomatic
 iii. 1st presentation, alone AF or AF secondary to precipitant like alcoholic,. CHF
 52.Indications of DC cardio version in AF are:
 i. Blood pressure less than 90 mmhg
 ii. chest pain
 III. heart failure
 iv. impaired consciousness.
 HR more than 200
63
 53.. Don't use rhythm control in asymptomatic Arterial fibrillation patients nor in patients with
permanent Arterial fibrillation.
 54.Don't use antiplatelet for stroke prevention in Arterial fibrillation
 55.History of Arterial fibrillation + enlarged left atrial size with previous DC cardio version the best
long term treatment will Arterial fibrillation ablation
 56.Drugs to avoid in Hypertrophic obstructive cardiomyopathy are: AIN
CARDIOLOGY PEARLS
 A=ACEI,
 I= inotropes
 N=Nitrates
 57. Young patient + dyspnoea + angina +s syncope + jerky pulse + double Apex beat + pulus
bisfergens is = Hypertrophic obstructive cardiomyopathy
 58.Ecg in Hypertrophic obstructive cardiomyopathy is:
 i. LVH
 ii. T wave inversion
 III. deep Q wave
 iv. Right bundle branch block
 V. PR prolongation
 59 .Treatment of Hypertrophic obstructive cardiomyopathy is ABCDE
 A= Amiodarone
 B= Beta blocker if Contraindicated then verapamil
 C= Cardioverter defibrators
 D=Dual chamber pacemaker
 E= Endocardial prophylaxis
 60. When to use ICD in HOCM=,
 Patients who survived a cardiac arrest due to VT,VF who has sustained VT causing syncope or
haemodynamic compromise .
64
NepHrology pearls
NEPHROLOGY PEARLS
 1. Azathioprine is associated with increased risk of non melanoma skin
cancer
 2. Renal angiogram investigation of choice for PAN
 3. 1st line treatment for Raynaud phenomenon is CCB nifidipine
 If severe ulceration give prostacyclin iloprost infusion
 4. Steroid use is known to precipitate scleroderma renal crisis
 5. Mainstay treatment for oxalate stone is =High fluid intake and calcium
carbonate
 6. Investigation of choice for renal stones is = Non contrast Ct scan
 In pregnancy =ultrasound
 7. IgA nephropathy occurs after 1 to 2 days for upper respiratory tract
infection VS post streptococcal glomerulonephritis which occurs 7 -14
days following group A streptococcal infection
 8. Alcoholic + haematuria =IgA nephropathy
 9. Main treatment of igA nephropathy is observation
 If proteinuria less than 3 then use ACEi
 If Proteinuria more than 3 then use Steriods
65
 10. Young patient with hypertension + abdominal pain + haematuria +
recurrent urinary tract infection + normal hb + ultrasound shows cysts
in kidney is = Autosomal polycystic kidney disease
 Treatment is = fluids and symptomatic
NEPHROLOGY PEARLS
 tolvaptan for decreasing annual rate of kidney growth 11.
 11.Hematuria shoes cyst rapture
 12. Loin pain shoes infection of cyst haemorrhage
 13 . Palpable purpura limbs, buttocks + abdominal pain + haematuria
and Proteinuria + arthritis + IgA deposit is = Henoch schonlein
purpura
 14. All patient with Hypertension and Proteinuria more than 1g per
day should be given ACEI
 15.Weight loss + neurological impairment on long standing dialysis
+joint pain and stiffness in upper limbs = Amyloidosis AL amyloid =
Myeloma ,waldenstrom , MGUS + cardiac ,CNS involvement,
macroglossia, perioribital ecchymosis
 AA amyloid=TB, bronchiectasis,
66
 15 .B2 macroglobulin on renal dialysis
 16. Loop diuretics causes calcium stones Thiazide diuretics prevent it.
 17. Fever + rash + arthralgia + eosinophilia + eosinophuria (pathognomonic)
NEPHROLOGY PEARLS
+ nonoliguric renal failure + no eosinophilia with NSAID + Proteinuria +
mononuclear infiltrate in intersium is =Acute interstial nephritis
 Treatment is drug withdrawal and steroids
 18 . Long standing dialysis + Renal failure + CNS abnormalities + joint pain
and stiffness in upper limb more than lower limb +beta 2 microglobulin is=
Amyloidosis
 Treatment with Renal transplantation
 19 . Haematuria + Loin pain + Abdominal mass + anaemia + Hypertension +
polchythemia + left varicocele is = Renal cell carcinoma
 ultrasound is investigation of choice
 Treatment for confined disease is partial or total nephrectomy For
advanced is tyrosine receptor inhibitor sunitinib >sorafenib
 20. Hodgkin lymphoma =minimal change disease
 Non Hodgkin lymphoma =Membranous Glomerulonephritis
67
 21. Malignancy + nephrotic range Proteinuria + IgG ,C3 deposition + Spike and
dome appearance is =Membranous Glomerulonephritis
 treatment = combination of cyclophosphamide and methylpredinsone
NEPHROLOGY PEARLS
 22. Pulmonary haemorrhage , haemoptysis + fever, haematuria + Proteinuria,
red cell cast + linear ig G deposit + increase Dclo + antiGM antibodies is=Good
pasture syndrome
 Treatment with iv methylpredinsone cyclophosphamide In severe cases
plasmaphresis
 23. Nephrotic range Proteinuria + raised creatinine + normal sized kidney s on
ultrasound scan + focal segmental glomerulonephritis + normal BP+ raised
immunoglobulins,raised cholesterol is=HIV nephropathy
 24. Treatment for high phosphate in end stage renal failure is =Sevalmer
Hyperparathyroidism + dialysis =if surgery is not option use cinacalcet
 25 Loin pain + peripheral leg oedema + acute renal injury + Proteinuria is
=renal vein thrombosis
 Treatment is life long warfarin
 26. Opioid of choice in syringe driver renal failure is =Alfentanil
 27 Kidney transplant recipients have high risk of developing non melanoma
skin cancer
68
 28 . Collapse/seizure/ ecstasy /coma/fall + acute kidney injury +High P,
High uric acid , High K , High Ck , low calcium is = Rhabdomylosis
 Treatment is IV fluid
NEPHROLOGY PEARLS
 29. All patients with diabetes and microabluminuria should be offered
with ACEI or ARBs irrespective of whether they have hypertension
 30 . Indication of iron therapy in CKD anaemia
 i) ferritin level less than 100
 ii) transferrin saturation less than 20 Percentage then give iv iron and
when there is functional iron defienancy i.e. transferrin saturation less
than 20% Give oral iron
 when there is no functional iron defienancy i.e. transferrin saturation
more than 20
 31 CKD +high calcium +high phosphate +high PTH is =tertiary
hyperparathyroidism
 Treatment is 1st line Para thyroidectomy
 If unfit for surgery then cinacalcet
69
 32 . Bilateral sensorneural deafness + corneal dystrophies, lens
abnormalities, retinitis pigmentosa + microscopic,marcoscopic haematuria
with or without Proteinuria + foam cells , basket wave pattern glomerular
basement membrane is = Alport syndrome
NEPHROLOGY PEARLS
 33. Children/young adults + nephrotic syndrome + selective Proteinuria +
normal Blood pressure + history of Hodgkin's lymphoma\ Nsaid use/gold/
lithium,rifamicin/+normal looking glomeruli on light microscopy or fusion of
podocytes on electron microscopy is =Minimal change disease
 Treatment is steroids if resistant then use cyclophosphamide
 34 . Urine sodium more than 30 +fraction of sodium excretion more than 1+
urea level more than 35 + urine osmolality less than 350 + brown granular
casts +no response to fluid is= Acute tubular narcosis
 36 . Marked loss of subcutaneous tissue from face + low c3 level+ linear
intramembranous deposit is = Membranoproliferative GN type 2 Lipid
lipidystrophy
 37 Nephrotic syndrome Proteinuria or haematuria + low C3 + sub
endothelial immuno complex deposit ,thickening and splitting capillary
membrane +hepatitis C /Cryoglobulimia is =Membranoproliferative GN type
1
 Treatment is steroids
 38 Antibiotic for peritoneal dialysis peritonitis is = Intraperitoneal
vancomycin and gentamicin
70
 39. 1st choice for vascular access for dialysis is = Arteriovenous fistula
 40. Short of breath + cough productive of fresh blood + Proteinuria +
haematuria + PANCA,CANCA is=microscopic polyangitis
NEPHROLOGY PEARLS
 41. Asthma + eosinophilia + renal failure +pulmonary haemorrhage + sensory
neuropathy + PANCA is = Chrug Strauss syndrome
 42 . 1st line treatment in secondary hyperparathyroidism is =Calcium acetate
 43 . Flush pulmonary edema + urinalysis worse on ACEI /ARBs + asymmetrical
kidney is = renal artery stenosis
 44. Investigation of choice for renal artery stenosis is = MR angiography
 45 . Renal artery stenosis 1st line is medical therapy
 In fibro muscular dysplasia 1st line is angioplasty
 46. Infancy/early childhood + recurrent urinary tract infection +small shrunken
scared kidneys + Hypertension is =Reflux nephropathy/chronic pyelonephritis
 Investigation of choice is excretion urography (micturating cystouthrogram)
 47. Normotension + alkalosis + hypercalciuria + hypokelmia + high urinary
chloride + high urinary sodium +high renin and aldosterone + hyponatremia
and hypochloremia + hyperplasia of JG apparatus is =Barter syndrome
 Treat with spironlectone,nsaids
71
 48.Normotension+hypokelmia+hypomagnesmia+hypocalcuria+metaboli
c alkalosis+ =Gittleman syndrome
 Treatment is spironlectone,nsaids
 49. Hypokelmia + hypertension + low renin and aldosterone is = Liddle
NEPHROLOGY PEARLS
syndrome Treatment is amiloride but not spironolactone
 50.. Low sodium +low k + normal urinary sodium and potassium is =
Diuretics abuse
 51 . [Renal transplant patient + sudden deterioration in renal function +
7 -21 days after + biopsy shows lymphocytes is = Acute cellular rejection
 Treatment with IV bolus of high steroids
 52 .Renal transplant patient after 4 weeks + gradual rise in creatinine
+pneumonitis , colitis ,oseophgitis + neutropenia is = Cmv infection
 Treatment give ganiclovir
 53 .Young woman +hypertension + high renin +high aldosterone is
=Fibro muscular dysplasia
 54.Urinary retention + catheter than pass urine +enlarged prostate is
=obstructive uropathy
 55.In renal transplant irradiated type of blood is indicated for blood
transfusion
72
 56.Angioplasty/ warfarin /CABG+ eosinophilia + Proteinuria+ purpura +
livedo reticularis + low C3 + high ESR is=Cholesterol embolization
 57. treatment of Renal cell carcinoma + solitary brain metastases is =
NEPHROLOGY PEARLS
nephrectomy + tyrosine kinase inhibitor Chemotherapy and
radiotherapy has no role in renal cell carcinoma
 58.Factory /rubber/printing/ cyclophosphamide + microscopic
haematuria +terminal dribbling + feeling to empty bladder is =
transitional cell carcinoma of bladder
 Treatment for localized tumours is transurethral tumour of resection
use of intravesical chemotherapy
 59 .Investigation of choice for bladder cancer is =cystoscopy
 60.Haematuria + Loin pain + Abdominal mass + anaemia +
Hypertension + polchythemia + left varicocele is=Renal cell carcinoma
 ultrasound is investigation of choice
 Treatment for confined disease is partial or total nephrectomy
 For advanced is tyrosine rec inhibitor sunitinib more than sorafenib
73
HAEMATOLOGY pEArLS
HAEMATOLOGY PEARLS
 1.Beta 2 microglobulin shows the prognosis in multiple Myeloma
 2.Absence of erythroblast + anaemia + normal WBC ,platelets + absent
reticulocytes + high iron and ferritin + antibodies to erythropoietin is=pure
red cell aplasia
 Treatment is discontinuation of EPO and repeated transfusion
 3. Venous/ arterial thrombosis + recurrent fetal loss + livedo reticularis +
low platelets +prolonged APTT ( fails to correct with addition of normal
human plasma ) History of SLE + lupus anticoagulant + anticardiolipin
antibodies is = Antiphospholipid syndrome
 4.Treatment of Antiphospholipid syndrome :
 Venous thrombosis= Warfarin with INR 2-3 for 6 month Recurrent venous
thrombosis= lifelong warfarin : if occurred while taking warfarin then
increase INR to 3-4
 Atrial thrombosis= lifelong warfarin target INR 2-3
 5. Treatment of Antiphospholipid syndrome in pregnancy is = Aspirin
+LMWH
74
 6. Causes of Extravascular haemolysis : WAHH:
 WA-warm Autoimmune
 H- hereditary spherocytosis
 H- Heamoglobinopathies i.e. Sickle cell,thalesmia
HAEMATOLOGY PEARLS
 H- Haemolytic disease of new born
 7. Warm autoimmune haemolytic anaemia has = IgG
 8.Cold Autoimmune haemolytic anaemia has = IgM
 9. Causes of warm autoimmune haemolytic anaemia are :
 Autoimmune disease=SLE
 Neoplasia : Lymphoma, CLL
 Drugs: Methyldopa, penicillin, cephalosporin, levodopa,Nsaids,Quindine (treated by
stopping drugs + oral Prednisolone)
 10. Causes of Cold autoimmune haemolytic anaemia are : Neoplasia: Lymphoma
Infections :Mycoplasma ,EBV ,legionella , malaria
 11.Treatment of autoimmune haemolytic anaemia: Warm: steroids
immnosupression,spelnectomy
 Cold : respond less to steroids
 12.Anemia+jaundice + splenomegaly + retic count more than 3 is = haemolytic anaemia
 13.Features of intravascular haemolytic anaemia : Heamoglobinuria Low hepatoglobin
Haemosiduria High LDH Heamoglobenimia
 14. Direct Combs test is diagnostic for haemolytic anaemia
 15. Treatment of Myelofibrosis :
 1st line: hydroxycarbamide
 interferon A and Bone marrow transplantation 75
 16.Diagnostic test for Myelofibrosis is = trephine bone marrow biopsy
 17. 50 -60 years + fatigue + massive splenomegaly + weight loss , night sweats + tear
drops poikilocytes + high WBC + high Platelets (initial) + dry tap + high LDH + Jak2 +
large abnormal platelet + portal HTN is = Myelofibrosis
HAEMATOLOGY PEARLS
 18.History of treatment chemotherapy for High grade lymphoma/ leukaemia + high K
+ High Phosphate + high uric acid + low Calcium + kidney injury (high creatinine ) is =
Tumour lysis syndrome
 19. Prevention of tumour lysis syndrome:
 Low risk : Hydration (IV fluids) + Allopurinol
 Intermediate risk: Allopurinol for 7days + IV fluids
 High risk : (high tumour burden, rapid turnover, renal impairment,age,drugs)
Rasburicase + IV fluid
 20. Never combine Rasburicase with Allopurinol when treating tumour lysis
syndrome
 21. Haematological disorders associated with Down syndrome are :
 Fanconi's anaemia
 Aplasia
 AML
 ALL
 22. Abdominal pain + peripheral neuropathy (low radial pulse,wrist drop +
constipation + blue lines on gums + lead level more than 10 + microcytic anaemia +
basophilic stipling + high serum or urine level of Delta aminolevulinic acid + high
urinary level of coporpohyrin other normal is =Lead poisoning
76
 23. Treatment of lead poisoning : DMSA for chronic poisoning
 EDTA for acute poisoning D penicillamine Dimercarpol
HAEMATOLOGY PEARLS
 24. Purpuric rash + isolated thrombocytopenia + normal PT + normal
APTT + high bleeding time + coombs positive + IgG antibody +
Megakaryocytes on bone marrow exam is = idiopathic
thrombocytopenic purpura
 Investigation is = Blood film exam.
 25. Treatment of ITP Asymptomatic = Observation
 platelets more than 30000 + no bleeding = Observe
 Platelets less than 30000 + mild bleeding = Oral Prednisolone
 Platelets less than 30000 after 3 minutes of steroids therapy =
Splenectomy
 Severe bleeding (GI,CNS) + Platelets less than 10000 = IVIG If
Splenectomy ineffective = Rituximab, azathioprine cyclophosphamide
 26. ITP + autoimmune haemolytic anaemia is = Evan's syndrome
 27. Massive painless lymphadenopathy in young person next step is to
Lymph node biopsy
77
 28. Avascular necrosis of hip + hand foot syndrome + dacylitis is = thrombotic crisis
 29. Acute chest syndrome + stroke is= sequestration crisis Stroke in it treated by
Exchange transfusion
HAEMATOLOGY PEARLS
 30. Sudden fall in haemoglobin without appropriate increase in reticulocytosis +
infection by parvovirus is =Aplastic crisis
 31. Treatment of sickle cell anaemia :
 Analgesia : opiates, Rehydration
 Oxygen Exchange transfusion if CNS complication Avoid iron therapy and
intraartucular steroids
 For preventing and acute complication use hydroxyurea
 32. Osteomyelitis in sickle cell is caused by salmonella
 33. Investigation for sickle cell anaemia is :
 Sickle cells
 Target cell Metabisulite screen Hb electrophoresis HbAs sickle cell trait protective
against falciparum malaria[
 34. Poor prognostic factors in AML
 I) Cytogenetic Deletion chromosome 5 or 7
 ii) age more than 60 years
 iii) more than 20% blasts after first course of chemo
 Iv ) 3q26 aberrations
78
 35.20 years + DIC + low platelets + Auer rods + t 15:17 is = APML M3
 Treatment is All trans retinoic acid ATRA plus Anthracycline
HAEMATOLOGY PEARLS
 36. Treatment of AML
 Initial: Cytarbine and Anthracycline Bone marrow transplantation
 37. M2:AML with maturation=most common t(8:21)
 M3 acute Promyleocytic :t (15:17) ,DIC
 M4:acute myelomonocytic inversion 16
 M5:monocytic :Gum organomegaly lymphadenopathy
 M7:megakarytotic :down syndrome in children less than 3 years and
Myelofibrosis
 38. Good prognostic factors in AML
 i) Promyleocytic leukaemia M3
 ii) t (8:21) and t(15:17)
 iii) inv 16
 39. 15-59 years + marrow failure + Gum infiltration +
hepatosplenomegaly + Auer rods myeloperoxidase positive + sudden
black positive is = AML
79
 40.Indications of treatment in CLL
 i) Lymphocytes doubling time of less than 6 months or more than 50% increase
over 2 months
 ii) bone marrow compromise anaemia, thrombocytopenia , neutropenia
HAEMATOLOGY PEARLS
 iii) autoimmune complication : ITP, autoimmune haemolysis
 iv) B symptoms (weight loss or Night sweats , fever more than 38 for more than 2
weeks)
 v) massive more than 10 cm or progressive lymphadenopathy
 vi) massive more than 6cm or progressive splenomegaly
 41. Immunotyping is investigation of CLL B CD19 postive,CD5, CD23 flow
cytometry smudge cells
 42. Poor prognostic factors in CLL
 i) male sex
 Ii) age more than 70 years
 iii)lymphocytes count more than 50
 iv) prolymphocytes more than 10% of blood lymphocytes
 iv) Lymphocytes doubling time less than 12 months
 vi) raised LDH vii) CD38 positive
 viii) chromosome del 17Good prognosis is chromosome 13 del
 43.Treatment of CLL FCR :
 Fludrabine,chrombicile or cyclophosamide,
 Rituximab 1st line: Chlorambucil
 2nd line Fludrabine : give cotrimazole as prophylaxis to prevent pumocytitis
jirvociIbrutinib when FCR ineffective 80
44. 40-50 years + anaemia , weight loss + massive splenomegaly + low LAP + left shift
leucocytosis + high Platelet + high basophils + Philadelphia chromosome 9:22 is = CML
45. Philadelphia chromosome t(9:22) has good prognosis in CML Poor in AML+ALL
HAEMATOLOGY PEARLS
46. Treatment of CML
1st line = Imatinib Hydroxyurea
Interferon alpha
Bone marrow transplantation
47. Thrombocytopenia + micro vascular haemolysis (normocytic anaemia, high LDH,

increased Indirect bilirubin, schistocytes )+ CNS signs + Renal impairment + Fever is
= Thrombotic thrombocytopenic purpura
48 Treatment of TTP
Plasma exchange is first line
Steroids after plasma exchange completed
49.Causes of TTP
Post infection : urinary or GI (E coli 0157 )
Pregnancy
Drugs : Cyclosporine, OCP , penicillin,metraonxole, clopidogrel, Acyclovir
SLE,
HIV 81
 50. Lab of TTP:
 Schistocytes
 Coombs negative
HAEMATOLOGY PEARLS
 Patient APTT normal
 Bleeding time prolonged
 51. Lupus anticoagulant does not correct when patient plasma is
mixed with normal plasma Factor VIII defiency correct more than 50%
with Normal plasma
 52. Factor VIII defienancy, Factor IX defiency , Vonwillbrand disease
These all correct with Mixed with normal human plasma
 53. Factor VIII inhibitor also don't correct with human plasma like
lupus anticoagulant
 In VIII inhibitor correct APTT with initial 50:50mix but when you
repeat APTT it doesn't correct
 54. Male African , mediaterian, + sudden anaemia and jaundice +
Heinz bodies, bite cells + low enzyme level + high reticulocytes count
is=G6PD defiency
82
 55. Causes causing Haemolysis in G6PD:
 PCS: P :Promaquine
 C: ciprofloxacin, chloramphenicol
 S: sulphonamides,sulphasalzine, sulfonylurea,
HAEMATOLOGY PEARLS
 Quinidine, nasid aspirin vitamin K probencid nitrofurantoin Fava beans
 56. Methamemoglobinemia in G6PD patient TREATED by Exchange transfusion
 57. Normocytic anaemia + family history gallstones is = hereditary spherocytosis
 58. Jaundice + splenomegaly + family history + gallstones + acute abdomen is =
Hereditary spherocytosis
 59. Lab in Hereditary spherocytosis:
 High MCHC
 High reticulocytosis
 Most accurate is eosin 5 meleimide
 Osmotic fragility test
 Osmotic gradient
 ekatacytomrtry different target between hereditary spherocytosis and Hereditary
stomatocytosis
 60. Treatment of hereditary spherocytosis:
 Folate replacement
 Splenectomy :best avoided until at least 6yeras of age to reduce risk of post
Splenectomy sepsis
83
eNDoCrINology pearls
ENDOCRINOLOGY PEARLS
 1.High oestrogen + high progesterone + low LH,FSH + high
prolactin + high Beta HCG is = pregnancy
 2.Normal oestrogen + high testosterone + LH high + FSH
normal + high FSH and LH ratio is = Polycystic Ovarian
syndrome.
 3.Low oestrogen + high FSH,LH is = premature ovarian failure
 Treatment : hormone replacement.
 4.Normal oestrogen + high FSH and LH is = resistant ovary
Syndrome.
 5.Elevated LH and testosterone with normal FSH = Polycystic
Ovarian syndrome.
 6.Testosterone >7 + hirutism + virilisation + deep voice +
ciltromegaly is =Adrenal or ovarian tumour.
84
 7.Tall + lack of secondary sexual characteristics + Gynaecomastia + low
testosterone + high LH FSH + firm small tests is = Klinefilters syndrome
 8.Investigation in Klinefilters syndrome:
 Low testosterone
 High LH FSH
 Karyotype 47,XXY,47XX
 Low HDL cholesterol
 high TGA
 Most appropriate test is FSH LH level.
 9.Treatment of Klinefilters syndrome =Testosterone to improve bone
minerization
 10.Anosmia + delayed puberty + low Testosterone, low FSH,LH +
normal height + Cryptorchidism + hearing
defects/cleft lip plate visual defect + primary amenorrhea + no mental
retardation is =Kallman's syndrome
 11.Investigation in Kallman's syndrome :
 Diagnostic test is FISH MRI =absent olfactory bulbs
 Low testosterone and low FSH LH
85
 12.Treatment of Kallman's Syndrome is :
 Pulses not continuous GnRH
 Once family is completed then testosterone.
 13. Klinefilters syndrome = Low testosterone + raised LH and FSH
 Kallman’s Syndrome = Low testosterone + Low FSH and LH.
 14.Primary hypogondasim ( Klinefilters syndrome ) = High LH + Low testosterone.
 Hypogondotrophic hypogondasim (Kallman’s Syndrome ) =Low LH and FSH + Low
testosterone .
 Androgen insensitivity syndrome =High LH + Normal / High testosterone.
 Testosterone secreting tumour = Low LH + High testosterone.
 15.thyrotoxicosis + goitre + Autoantibodies + thyroid eye disease is =Graves disease .
 16. 5 hypo’s in Addison’s disease:
 Hypotension (postural )
 Hypoglycaemia
 Hyponatremia
 Hypo aldosterone
 HypoPH
 17. 2 HYPER in Addison’s disease :
 Hyperkalaemia
 Hyperreninemia .

86
 18.Patient of Addison’s disease who undertaken strenuous
activity should double their dose of glucocorticoid and
mineralocorticoids .
 19.lethargy , weakness + anorexia + nausea , vomiting +
weight loss + hyperpigmentation at palmer or buccal mucosa
+ loss of pubic hairs + hypotension + high K + Low sodium is =
Addison’s disease
 20.treatment of Addison’s disease is :
 Hydrocortisone 100 mg IV TDS.
 Fludrocortisone for postural drop
 21. In Addison’s disease there is low T4 and high TSH so never
treat thyroid problems treat Addison’s thyroid will become
normal .
 22.treatment of thyroid overdose is :
 Propranolol
 Plasmaphresis in severe cases.
 Cholestrayamine.
87
• 23. Investigation in Addison disease:
• ACTH stimulation test(short synacthen test) After giving synacthen of 250ug normally
there increase cortisol of greater than 550 if below this confirm diagnose of adrenal
insufficiency to dx localize it we do long synacthen test where if cortisol raise then it's
secondary adrenal insufficiency if not then it's Primary.
• 24.Other tests in Addison’s diseases :
• Adrenal autoantibodies anti21 hydroxylase Ab
• 9am cortisol and ACTH test low Cortisol and high ACTH
• Metabolic acidosis
• Macrocytic anaemia pernious
• Blood: high Eosinophila,lymphocytosis , neutropenia mild hypercalcemia.
• 25.Causes of Addison’s diseases:
• Autoimmune (most common)Infections TB = do CT abdomen showing shrinkage of
adrenals
• Hiv
• Cmv
• Antiphospholipid syndrome (Hughes syndrome)
• Waterhouse fried ache syndrome Metastasis (bronchial breast kidney)
• 26. Female patient with history of recurrent DVT and confirmed hypoaldostrone low
sodium high K positive short synacthen test is = Antiphospholipid syndrome ( Hughes
syndrome)

88
 27.Sepsis / surgery/ steroid withdrawal/infection +
hypotension + hypothermia + syncope + convulsions +
hyponatremia + hyperkalaemia + hypoglycaemia is =
Addisonian crisis
 28.Treatment=IV fluids IL normal saline and steroids IV
hydrocortisone 100mg of IV Dexamethasone
 29.Tiredness Lethargy + postural Hypotension + high ESR
+ DIC + purpura + hyponatremia high K is =Waterhouse
fridirch syndrome Treatment=IV fluids and IV
hydrocortisone
 30.Low ACTH + no skin pigmentation + no hyperkalaemia
+ BP normal + low Cortisol + normal aldosterone is =
secondary hypoadrenalsim
 Treatment : only glucocorticoid.
 31.Cortisol curve can be used to asses how appropriate
dosing of glucocorticoid steroids in Addison patient.
89
 32.Expothalmus + diplopia + conjunctival oedema + optic disc swelling +
opthalmoplegia + inability to close eye lids lid lag lid retraction +
eu,hypo,hyperthyroid is =Thyroid eye disease.
 33.Management of Thyroid eye disease :
 Stop smoking
 Stop Radioiodine
 Use topical lubricant
 High dose steroids
 Orbital decompression
 In replased or active disease = Radiotherapy
 Malignant exophthalmos,,= steroids
 34.Referral to Ophthalmologist in Thyroid eye diseases:
 Unexplained sudden deterioration in vision
 Change in intensity or quality of colour
 eye pooping out globe subluxation
 Corneal opacity
 Optic disc swelling
 35. Thyrotoxicosis + goitre + autoantibodies + Thyroid eye disease is =
Graves disease
90
 36.Specific features in graves but not in other causes of thyrotoxicosis
 Eye signs (30%) exophthalmos, opthalmoplegia
 Pretibial myxoedema (most specific)
 Thyroid bruit
 Thyroid acropacy.
 37.Investigation in graves disease
 AntiTSH receptor stimulating antibodies (thyroid stimulating immunoglobins)(specific)
 Anti thyroid peroxidase TPO antibodies
 Increased level of SHBG
 Globally increased uptake on thyroid scanT4,T3 high but T3 more specific.
 38.Treatment of graves disease:
 Propranolol block adrengenic initials
 Carbimazole 40mg for 12-18 Mon block thyroid peroxidase SE: agranulocytosis ( sore
throat)
 Treatment : stop drug start PTU once neutrophils recover Carbimazole should be
stopped when neutrophils less than 1.5Infection :
 antibiotic (cephalosporin)G-CSF Erythromycin increase it's activity
 Definitive treatment of thyrotoxicosis is Radioiodine only indication is
 toxic multinodular goitre and single toxic adenoma Surgery.
 39.Contraindications to Radioiodine therapy : Pregnancy avoid at least 4-6 Mon and
breast feeding Age less than 16yearsThyroid eye diseases
91
 40.Indications for Surgery total Thyroidectomy:
 Large goitre compression
 Symptoms Intolerant to drugs.
 41. Side effects of thyroid surgery:
 Transient hypoparathyroidism
 hypocalcaemia
 Tetany
 Infections
 Bleeding Superior laryngeal nerve palsy
 Permanent recurrent laryngeal nerve plasy
 42.Gold standard test for diagnosis of growth hormone defiency is = Insulin
tolerance test insulin induced hypoglycaemia = GH response of less than
9mU/L when it is contraindicated (Epilepsy) use Alginate or glucagon test
 Treatment: replacement therapy with biosynthetic human GH[
 43.Weight gain + intermittent sweating + hypoglycaemia (feel hungry sweaty
tremors diplopia weakness ),+ early in morning or just before meal + high
insulin + high c peptide + high proinsulin :insulin ratio is = Insulinoma
 treatment: surgery
 If not fit for surgery : Diazoxide and somatostatin
 44.Radioiodine therapy should be avoided 8 weeks following CT contrast.
92
45.Investigation in Insulinoma:
Supervised , prolonged fasting (up to 72 hours)
CT pancreases 90%are less than 2cm in size.
46.High insulin + high C peptide + high proinsulin + normal SU level = Insulinoma
High insulin + high C peptide + high SU level is= sulphonylurea overdose
High insulin + low C peptide = Exogenous insulin or insulin misuse
Low insulin + low C peptide is = non beta cell tumour
47.Causes of hypoglycaemia less than 60mg/dl:
Insulinoma
Self administration
insulin/ sulphonylurea
Liver failure
Alcohol
Addison disease
48.sweating + confusion + headache + hunger + tremors + diplopia = Hypoglycaemia
49.Treatment of hypoglycaemia :
Patient is conscious = oral glucose
Patient is unconscious = 50ml of 50%Dextrose water , IV Glucagon
50. Type 2 DM + bilateral Quadriceps wasting weakness + diminished knee reflex (LMNL)+pain in
hip buttock and thigh burning pain at night + ankle reflexes preserved and planters could be
extensor or flexor + EMG Multifocal denervation in paraspinous and leg muscles is = Diabetic
amyotrophy
93
Treatment :resolves with improved glycaemic control and drugs
51.Hyponatermia + urine sodium more than 20 + low plasma osmolality less than 270 + high urine
osmolality more than 1000 or more than 300 is = SIADH
52.Causes of SIADH are :
Cancer : small cell lung cancer, pancreatic and prostate
CNS : stroke, subarachnoid haemorrhage, subdural haemorrhages, meningitis/encephalitis/abscess
,head injury/neurosurgery operation, Infections : Tuberculosis pneumonia
Drugs: Sulphonylurea, SSRI , TCA,. Antipsychotics (Haloperidol,quetapine , clozapine Carbamazepine
Thiazide , Vincristine, Cyclophosamide, Omeprazole
Other: positive end expiratory pressure (PEEP) Porphyria
53.Treatment of SIADH :
1st line : Fluid restriction (750-1000)
ADH V2 receptors antagonist = tolvaptan Demeclocycline :reduces responsiveness to ADH used
In refractory cases
Hypertonic saline in severe case like fits Slowly correct sodium other CPM
54.T scores > -1 =Normal

T score b/w -1 to -2.5 =osteopenia
T score less than -2.5=osteoporosis
94
 55.Lady with hysterectomy has risk for osteoporosis give unopposed
oestrogen
 56.Family history+ high plasma Calcium + low Urine calcium is = Familial
hypocalcuric hypercalcemia
 Treatment : no treatment
 57.Best initial treatment for carcinoid Syndrome is = somatostatin
analogues (octreotide) Then Hepatic artery embolization
 58.Viral infection + tender Goitre + high ESR + globally reduced uptake
on radioactive iodine(,or no uptake) + initially hyperthyroidism then
hypothyroidism is = Sub acute (De Quervain's ) thyroiditis
 59.Treatment of DeQuervain thyroiditis :
 Usually self limiting no treatment Thyroid pain= aspirin or other Nsaids
Steriods if hypothyroidism
 Beta blockers to control tremor No role of antithyroid drugs
 60.Radioactive iodine uptake (RAI 131 scan)In graves = high
homogeneous diffuse uptake
 Toxic nodular goitre = patchy uptake or solitary area of high uptake
 DeQuervain thyroiditis=no uptake or reduced uptake
95
rHeuMatology pearls
RHEUMATOLOGY PEARLS
 1. Poorly controlled Rheumatoid arthritis + Proteinuria+
hypoalbuminemia is=Systematic Amyloidosis, Do rectal
biopsy
 2. Elderly man +pain and stiffness in shoulder pelvic girdle
proximal not weakness is=polymyalgia rheumatica ,check
ESR level
 3.Turkey patient + oral ulcers + genetic ulcers + anterior
uveitis + thrombosis + aseptic meningitis + abdominal pain
+ diarrhoea colitis + erythema nodsum is = Behcets
syndrome
 4. Urethritis + conjunctivitis + Arthritis + history of GI
infection + brown papules on palms and soles + circinate
balnatis is = Reactive Arthritis
96
 5. Bone fractures + bone pain + low calcium + low phosphate + high Alp
+ high PTH + losser's zone on x-ray is= Osteomalacia
RHEUMATOLOGY PEARLS
 6. Foot drop + abdominal pain + livedo reticularis + renal failure + HTN +
purpura + testicular pain + Hep B serology +No lung involvement is=
Polyarteritis nodusa
 7. Arabs,itians ,Turks Jews azarbijans+fever+abdominal pain +signs of
peritonitis + pluritis+leg joint involvement+ inflammation of tunica
vaginals + increase WBC c Reactive is=Familial mediaterian fever give
colchicine
 8. Dull shoulder pain + global restriction of shoulder movement in all
direction +external rotation more effected +pain at rest +movement
effected in active and passive +diagnosis is clinical no investigation is
required is=Adhesive capsulitis
 9. Raynaud disease + tight skin in face +below elbow and below knee+
anti centromere antibodies + scerlodactly + oesophageal dysmotity
+calcinosis is=Crest syndrome
 10.Antibody showing renal crisis in systematic sclerosis is= anti RNA
polymerase III antibody
97
 11. +Tightening of skin in upper limb above elbow lower limb
above knee trunk +Hypertension + lung fibrosis + renal
involvement + anti scl 70 is =Diffuse cutaneous systematic
RHEUMATOLOGY PEARLS
sclerosis
 12. Foot drop ,ulnar nerve palsy + purpuric rash +arthralgia + low
C4 level is = Cryoglobulimia
 13. Old patient +pain on base of thumb + tenderness and
swelling on 1st carpometacarpal joint + crepitus +pain on
abduction of thumb + atrophy of thenar muscles
is=Osteoarthritis
 14. Old man +weakness in finger flexors + weakness of shoulders
+ difficulty in swallowing + Ck level normal + muscle biopsy
shows internuclear or cytoplasmic tubofilaments is =Inclusion
body myositis
98
 15. Women patient + anticardiolipin antibody + lupus anticoagulant
+high Aptt (does not improve after human plasma )+venous ,arterial
thrombosis + low platelets is= Antiphospholipid antibody syndrome
RHEUMATOLOGY PEARLS
 16. Don't give anticoagulation in Behcets even with thrombosis give
steroids
 17. Cyclophosphamide causes premature ovarian failure and infertility
 18. Raynaud phenomenon + myositis + fibrosing alevolitis + mechanic
hands i.e. thickened ,cracking and peeling skin +Ck level high +proximal
myopathy+anti jo1 antibody is =anti synthase syndrome /polymyositis
• 19.Spastic paraplegia +upper motor signs in lower limbs +urinary
retention +HTLV1 positive is = Tropical spastic Para paresis
• 20. Massive hepatosplenomegaly + pancytopenia + bone fractures +
yellow papules (pingueculae )+no brain pathology +Erlenmeyer flask
shaped cyst is = Gaucher disease
• 21. Long term management in patient with idiopathic intracranial
Hypertension is =weight loss
99
 22. Pauci articular still disease has ANA positive but
systematic still disease has negative ANA + RF
 23. Pain and swelling over lateral dorsal aspect of wrist
RHEUMATOLOGY PEARLS
+Finklestein test positive is=De Quervain's tenosynovitis
 24.Hip replacement gram positive bacillus think of =
propionibacterium acnes
 25. Organism associated with development of RA is
=Proteus mirablis
 26. Gout +warfarin use give = Rasburicase
 27. African Caribbean lady +Well demarcated macular
rash with erythema ,scales, plaques atrophy +
photosensivity +scaring alopecia + negative ANA and anti
dsdna is=Discoid lupus
 28. Swollen tender mass in calf + Doppler u/s shows
compressible lumen + osteoarthtris is = Baker's cyst
100
 29. 30 year old + absent limb pulses + unequal blood pressure in
upper limbs + Carotid bruit + claudication + TIA + angina + aortic
RHEUMATOLOGY PEARLS
regurgitation + glomerulonephritis + high ESR Crp is = Takayasu's
disease
 treatment with steroids
 30.Best way to differentiate primary Raynaud Disease and
Raynaud secondary to connectivity tissue disease is =Nail fold
capillarsocopy i.e. distorted missed nail fold capillary loops
 31. Confirmation test for carpal tunnel syndrome is=EMG /nerve
conduction studies
 32 . Smoker + pain on walking + digital ulcerations + cyanosis and
gangrene of fingers and toes + absence of pulses in radial, dorsal
pedis tibial artery +burning sensation in fingers is = Burger's
disease
101
 33.⛹♂Sitting down..... relieve the pain of spinal stenosis.⛹♂Sitting
down..... aggravate the disc prolapse pain .
RHEUMATOLOGY PEARLS
 both cause low back pain which extended to the LEG.
 34. Back pain + leg raise pain aggravated +sitting relives pain or
leaning forward while walking +pain with extension of lumbar spine +
loss of lumbar lardosis is=spinal stenosis
 35. 4 to 8 years of age +hip joint hip pain + limp + decrease hip
movement +x-ray widening of joint space + decrease femoral head
size is= perthes disease
 36. Drug for long term renal involvement in SLE is =Mycophenolate
mofetil
 37. Stains has interaction with grape fruit juice
 38. cute gout + colchine contraindicated + small joints involvement +
renal failure = give oral steroids not intraarticular that is used for large
joint involvement
 39. SLE: normal CRP unless an infection
102
 40. The recommended treatment for myelosuppression secondary to her
methotrexate therapy is with folinic acid rescue therapy
 41. Bilateral proximal myopathy + neuropathic pain in thighs +absence of
lumbosacral structural lesson is =Diabetic amyotrophy
RHEUMATOLOGY PEARLS
 42. Loin pain + haematuria in Antiphospholipid syndrome -> renal vein
thrombus
 43. Osteoporosis treatment
 1st line oral bisphosphonates
 1st aldereonate if contraindicated then risedronate or etidronate
 2nd line raloxifene and strontium Donosumb
 Raloxifene contraindicated in thromboembolism
 Strontium contraindicated in thromboembolism
 Teriparatide contraindicated in previous hyperparathyroidism
 Donosumb has side effects of diarrhoea ,dyspnoea ,hypocalcaemia and
upper respiratory tract infection.
 44. Bisphosphonates and Donosumb used to prevent pathological fractures in
bone metastasis .
 if eGFR less than 30 , Donosumb is preferred Donosumb is not used for
preventing skeletal related events with bone Mets from prostate carcinoma
103
• 45. Painting/playing tennis +pain and tenderness in lateral epicondyle +
pain worse on wrist extension against resistance with elbow extended
RHEUMATOLOGY PEARLS
or supination of forearm with elbow extended +pain on wrist
dorsiflexion and middle finger extension is= Lateral epicondylitis /tennis
elbow
• 46. Painful abduction between 60 to 120 degree + tenderness over
anterior acromion + calcification on x-ray is=supraspinatus tendonitis/
Sub acromial impingement painful arc
• 47. Pain through out body with tender points + lethargy + sleep
disturbance , headache + normal blood lab normal ESR is = Fibromyalgia
treatment is explanation, aerobics exercise, CBT
• drugs :pregablin ,duloxetine, amitriptyline
• 48 . Methotrexate used as a steroids sparing agent in difficult to control
, frequently relapsing giant cell arteritis
• 49. Elastic fragile skin + recurrent joint dislocation easy bruising + aortic
regurgitation + MVP + subarachnoid haemorrhage + angiod retinal
streaks + type 3 Collagen is =Ehler danlos syndrome
104
 50. 10 to 15 years of age + obese child +knee or distal
thigh pain + loss of internal rotation of leg in flexion
RHEUMATOLOGY PEARLS
+displacement of femoral head epiphysis posterior
inferiorly is =Slipped upper femoral epiphysis
 51.SLE + Systematic sclerosis + Polymyositis +Raynaud
phenomenon + puffy hands + arthralgia + myalgia
AntiRNP positive is =Mixed connective tissue disorder
 52. Fever more than 5 days + cervical lymphadenopathy
+ erythema and oedema of palms and soles with
desquamation of skin + nonpurlent bilateral
conjunctivitis + strawberry tongue + coronary artery
aneurysm On Echo =Kawasaki disease /
Lymphomucocutaneous disease
 Treatment give aspirin and IVIG
105
53. NICE They now recommend disease-
modifying anti rheumatic drug (DMARD)
RHEUMATOLOGY PEARLS
monotherapy with a short-course of bridging
prednisolone. In the past dual DMARD therapy
was advocated as the initial step.
54.Multiple small joints + gout = oral steroids for
large joint use intraarticular steroids
55.Methotrxate can be used as steroid sparing
agent in giant cell arteritis
56. 3 weeks of osteomyelitis = x-ray foot not
MRI
106
57.Systmatic sclerosis + lung involvement
restrictive pattern treated by = high dose oral
RHEUMATOLOGY PEARLS
steroids and cyclophosamide
58.RCP guidance states that individuals should
be given prophylaxis against osteoporosis if they :
Are under 65 years Require steroids for longer
than 3 month a have T score of less than -1.5
59.Best way to monitor disease activity in Paget
disease is = 6 monthly alkaline phosphatase level
60.In Paget disease skeletal survey >bone scan
107
INfECTIOUS DISEASE pEArLS
INFECTIOUS DISEASE PEARLS

 1.. Patient presents with dysuria +urethral discharge + gram
staining shows neutrophils but no bacteria is= Chlamydia
trochmatis
 2.Azithromycin is treatment of choice for Lymph granuloma
venrum.
 3.Meningitis + brainstem involvement + immunocompromised
patient is = Listeria meningitis
 4.Ataxia + seizures + headache + menigism + pneumonia +
diarrhoea + not responding to cephalosporin + trumblibg motility
is = Listeria monocytogenes
 Diagnosed by blood Culture
 5.Treatment of Listeria meningitis : IV amoxicillin/ampicillin and
gentamicin (cephalosporin usually inadequate)
 6.Lymphocytic CSF predominates in TB and fungal meningitis
108
 7.Urethral discharge + dysuria + gram negative dipplococci =
Gonorrhoea
 8.Tenosynovitis+migratory polyarthritis + dermatitis = disseminated

gonococcoal infection
 9.Patient with Gonorrhoea received ceftriaxone but unfortunately his
symptoms have not resolved is = coexistent infection chlamydia
 10. Treatment of Gonorrhoea
 Cephalosporin (cefixime or ceftriaxone) Is treatment of choice
 Ciprofloxacin was used
 11.Investigation for Gonorrhoea Standard Culture fail to grow selective
media is needed like Thayer Martin medium
 12.Dysuria + penile discharge thin colourless + had sexual intercourse +
urethral swab 10PMN/HPF no bactermia is = nongonococal urethritis
 13.Treatment: doxycycline 7 days or azithromycin Erythromycin is 2nd
line
 14..Complications of Gonorrhoea
 Local: urethral stricture Epidymitis Salpingits (infertility)
 DG Imononarthritis + pustular rash synovial fluid is suggestive of joint
sepsis in young woman is gonococcal arthritis
109
 16. HIV patient + Cottage cheese and tomato ketchup or (pizza) appearance
is = CMV Retinitis

 Treatment: Ganiclovir (Side effects : myelosuppression do CBC) Foscarnet If
both contraindicated give = Cidovir
 17.Dyspanae + CD count less 200 + dry cough + fever + exercise induced
desaturation +
 Lymphadenopathy + choroid lesion + HSM + very few chest signs is =
pneumocystis jiroveci pneumonia
 18.Lab in pneumocystis jiroveci pneumonia
 CXR : bilateral interstial pulmonary infiltrates lobar consolidation or normal
 Exercise induced desaturation
 BAL silver stain showing cysts
 19.Treatment of pneumocystis jiroveci pneumonia :
 Co -Trimoxazole
 IV Clindamycin(not used as prophylaxis)
 IV pentamidine
 severe cases Steriods when Hypoxic PO2 less than 9.3kpa or less than
70mmhgDapsone
 20.Treatment of lung abscess = Cefuroxime + metronidazole
110
 21. History of sinusitis + fever+ headache CNS signs + seizure + meningeal irritation +
ring enhancing lesion on CT scan is = pyogenic brain abscess.

 22. DD of Ring enhancing lesions :
 Pyogenic brain abscess
 Toxoplasmosis
 Cerebral metastases
 Histoplasmosis
 Primary brain tumours giloblastoma multiforme
 23. Walking barefoot + abdominal pain + Diarrhoea + pneumonitis + papulovesicular
rash on soles of feet buttocks linear rash over groin(larva current) + eosinophilia =
Strongyloides stercoralis
 24. Treatment Strongyloides stercoralis :
 Ivermectin
 Albendazole
 Thiabendazole
 25.if patient has Strongyloides and HIV diarrhoea then treat 1st Strongyloides then HIV
 26.Children + perianal itching at night + sticky plastic tape at perianal area and see eggs
is = Enterobius vermicularis(pinworm)
 Treatment : bendazoles i.e. menbendazole
111
 27.Nemtodes which causes anaemia is = ancylostoma duodenale N nector

Americans
 Treatment: bendazoles.
 28.Rainforest region + transmitted by chrysops deerfly + Itchy red swelling
below skin Calabar swelling + urticaria + pruritis + eye work is= Loiasis loa
loa
 Treatment : diethylcarbamazine
 Ivermectin (DOC) Both drugs contraindicated if microfilals exceeds 2500
 29.Eating raw pork + fever + perioribital oedema +myositis is = trichinella
spiralis
 Treatment: bendazoles
 30.Black files + blindness + hyper pigmented skin + allergic reaction to
microfilaria is = onchocerca volvus
 Treatment: ivermectin River blindness
 31.Lyphmodema elephantiasis = wanchere bancrofti Tropical eosinophilia
=mylasia fatigue w8 loss cough dyspnoea lymphadenopathy high level of
eosinophilia + bilateral reticulocytosis shadowing
 Treatment : Diethylcarbamzine
112
 32 Dog faces eggs + visceral larva migrans + eye granulomas, liver lung
involvement is = toxocara canis
 Treatment : diethylcarbamazine

 33. Pneumonitis + intestinal obstruction + Loffler's syndrome + biliary
pancreatic duct obstruction = Ascaris
 Treatment: piperazine for bowel obstruction
 Menbendazole for other infections.
 34.Painful liver mass + flushing urticaria + anaphylactic reaction + liver cyst
obstructive jaundice + Ct abdomen best test is = hydatid disease
 Treatment: Albendazole and aspiration.
 35.Seizures + Ct brain periventricular cystic lesion in partial love Swiss cheese
appearance ,= Neurocysticerosis Taniae solium (uncooked pork) Taniae
saginata (beef)
 Treatment : niclosamide
 36.Swimmer's itch + haematuria + bladder calcification (Squamous cell
 carcinoma) + frequency = Schistoma haematobium
 Schistoma japonicum causes spinal cord compression
37.Treatment of schistosomiasis:
 S.haematobium and S.mansoni = Praziquantel 40mg for 3days
 S.japonicum = Praziquantel 60 mg for 6days+Prednisone 1mg
113
 38. Cholangiocarcinoma = clonirchis sinensis
 Treatment: Praziquantel

 39.Same as tuberculosis + brown red sputum + fever night sweats
rashes urticaria + eosinophilia + symptoms not as severe as
tuberculosis is = Paragonimiasis
 Treatment: Praziquantel
 40.Cutaneous larva migrans = Ancylostoma brazillience
 Visceral larva migrans = toxocara canis
 Treatment of Ancylostoma brazillience = Ivermectin
 41. High fever + stridor + drooling saliva (specific sign) + rapid onset +
cheery red epiglottis is = Acute epiglottitis
 Organism : Haemophilus influenza type B
 42.Lab of acute epiglottis
 Preferred method : Direct visualization of epiglottis cheery red
epiglottis Lateral neck radiographs=swollen epiglottis (thumb
sign)Blood Culture]
 43.Cough =croup Drooling of saliva=Acute epiglottitis is
Laryngomalcia improve in prone position
114
 44. Treatment of acute epiglottitis
 Unstable=early intubation

 Stable,=ICU monitoring 3rd generation cephalosporin ceftriaxone Hib vaccine
rifampicin prophylaxis
 45. Widespread pruritis + linear burrows on side of fingers ,interdital webs + flexor
aspects of wrist + skin scrapings sarcoptes scabei =scabies
 46.Treatment of scabies:
 1st line : permethrin 5%
 2nd line : Malathion 5%
 47.Suppressed immunity +HIV patient + crusted skin scabies Is = Crusted(Norwegian)
scabies
 Treatment : Ivermectin
 48.Cattle sheep /unpasteurized milk infected cow in abattoirs +fever chills sweats +
confusion +abdominal pain diarrhoea + hepatosplenomegaly ,+ low platelets +
Vasculitis rash is = Q fever coxiella burneti
 49.Q fever Endocarditis:
 Aortic valve involvement Murmur not always present.
 low grade fever(or no fever)
 Signs of heart failure
 Clubbing
 Hepatosplenomegaly
 Vasculitic rash
115
 50. Lab of Q fever:
 Confirmation Q fever antibody coxiella burneti IgG or igA greater than 1:2000
 Anaemia

 Low PLT
 High ESR
 High immunoglobulin's
 Abnormal LFTS
 Haematuria
 51.Doxycycline is treatment of choice , Macrolides
 52.Decreased consciousness , dysphagia + epilepsy history or Alcohol history + fever+
features of pneumonia is = Aspiration pneumonia
 Treatment: amoxicillin + metronidazole
 53. Risk factors of Aspiration pneumonia:
 Epilepsy
 High alcohol intake
 Use of recreational drugs with history of drug overdose.
 54.Altered mental status + fever headache + neck stiffness + seizures + erratic
behaviour + Ct or MRI mass in temporal love for lap high protein, high lymphocytes,
normal csf glucose +PCR for HSV is=Herpes encephalitis
 Treatment : HSV encephalitis = IV/acyclovir Acyclovir resistant =Foscarnet
 55.HSV encephalitis is confirmed by =CSF PCR HSV
116
 56. Business man + fever + pharyngitis + generalized lymphadenopathy
+ maculopapular rash + mouth ulcers + low WBCS Lymphocytes low

platelets ,atypical Lymphocytes is = Acute HIV disease ,(seroconversion
illness).
 57. Hiv (RNA )PCR and p24antigen confirm diagnosis of acute HIV
disease seroconversion illness
 58.Infectious mononucleosis in teenage years and rash after ampicillin
unlike HIV illness.
 59.Flow cytometry used measure CD4 count in HIV patients : CD4 less
than 350 = opportunistic infections
 CD4 less than 200 = 80%risk of developing OI in 3years
 CD4 100-200=PCP and Oesophageal candidiasis
 CD4 less than 50= disseminated mycobacterium avium complex and
CMV Retinitis
 blood Culture next step to confirm to diagnose
 60.Start antiretroviral therapy in every HIV positive individual regardless
of CD4 count
117
DerMatology pearls
1.Symetrical + brown + velvet plaques on neck, axilla and groin is acanthosis nigricans
DERMATOLOGY PEARLS
2.Causes of Acanthosis nigricans:
Adenocarcinoma of stomach
DM
Obesity
PCOS
Acromegaly
Cushing syndrome
Hypothyroidism
Familial Prader Willi syndrome
Drugs: OCP nicotinic acid
3.Shiny painless areas if yellow red skin on shin of DM patient thickened blood vessel is = Nacrobiasis lipodica
Treatment : topical steroids Injectable steroids Camouflage creams
4.Tender erythema nodular lesion on shins is = Erythema nodsum
Treatment: usually resolve with in 6weeksNsaids ,light compression.
5.Causes of Erythema nodsum:
Streptococcus infection most common, Brucellosis , tuberculosis ,
sarcodosis ,
IBD.
Behcets
SLE
malignancy 118
6. Drugs causing Erythema nodsum :
OCP
Sulphonamides
DERMATOLOGY PEARLS
Penicillin
Antipyretics
Montoleukast
Hepatitis B vaccination
Omeprazole
Pregnancy
HLA B 27 27
7.Pinkish pearly white papules with central umbilical on occur any where except palms and soles + children +
HIV less than 200 count is = Molluscum contagiosum by pox virus
Treatment: usually resolved watchful waiting
Troublesome : simple trauma cryotherapy topical imiquoid cathardin Itchy : topical steroids fusidic acid.
8.Skin disease associated with HIV :
Molluscum contagiosum
Corweign scabies
Saborhic dermatitis
9.Sysmmetrical erythematous lesion and raised pinkish indurated lesion and shiny orange peel skin is =
Pretibial myxoedema seen in graves disease
10.Skin disorders with Tuberculosis is :
Lupus Vulgaris
Erythema nodsum
Scarring alopecia
Scrofuloderma
Verrucosa cutis
Gumma 119
 11.Erythmatous flat plaque elevated ulcerated with apply jelly
colour and centre scar is = lupus vulagris
 Treatment : antiTuberculosis Drugs
DERMATOLOGY PEARLS
 12.Papular lesion hyper pigmented depressed centrally
associated with DM,HIV lymphoma is = Granulomas annulare
 Treatment: resolved spontaneous Steriods
 13.Mainstay treatment of granuloma annulare is =
Observation.
 14.Infrated radiation sitting to fire heater + reticulated
erythematous patches hyperpigemented telangiectasia +
hypothyroidism is = Erythema Ab igne If not treated with
develop squamous cell cancer
 15.Well circumscribed raised erythematous lesion on finger
tender which bleeds when touched =pyogenic granuloma.
 16.Solitary lesion with central areas of ulceration volcano or
crater is = Keratoacanthoma
 Treatment : sponatoulsy regress with in 3minSuch lesion
should be excited
120
 17.Red indurated papules later narcotic black easchar at centre +
middle East with cattle/sheep/goat is = Cutaneous anthrax
 Treatment: resolve on 80-90% Penicillin for treating infection.
 18.IgA deposit within blood vessel = HSP Granular IgA deposit in
DERMATOLOGY PEARLS
Basement membrane is = dermatitis herpertiformris
 Intracellular igA deposit in pemphigus.
 19.Streptococal sore throat 2-4 weeks + tear drop scaly papules on
trunk and limbs is = Guttate psoriasis
 Treatment: if lesion not widespread (<10%body surface areas) not
impacted physically, psychologically or socially = no treatment
resolved within 2-3month
 if patient desire treatment then topical agents
 If lesion widespread >10%body surface area =Refer urgent
dermatologist phototherapy UVB phototherapy = recurrent episodes
referral ENT should be considered = Tonsillectomy.
 20.Erythmatous sharply demarcated papules and rounded plaques
covered by silvery scales +HLA-B13,B17 cw6 + nail pitting oncycholysis
koebnar phenomenon + anterior uveitis = psoriasis
121
21.Complications of Psoriasis are :
Psoriatic arthropathy
Metabolic syndrome
Increased CVS disease
Venous thromboembolism Psychologically distress
DERMATOLOGY PEARLS
22. Drugs causing psoriasis are :
Beta blockers
Lithium
Antimalarial (chloroquine, hydroxychloroquine)
Gold
Nsaids
ACEi infliximab BB >ACEI
Withdrawal systematic steroid
Trauma
Alchols
23.Treatment of Psoriasis :
Topical steroids 1st line : potent steroids once daily + vitamin D
2nd line: vitamin D twice daily
Third line : potent steroids twice daily diathronl Side effects are :steroids skin atrophy striae rebound
symptoms.
Secondary management : UV B light : phototherapy psoralen + UV A light (PUVA) it's Side affects are : skin
ageing Squamous cell carcinoma Systematic :oral methotrexate cyclosporine TNF inhibitor like Brodalumab =
IL-17
Rituximab=CD20
Toculzumab =IL-6
Ustekinumab =IL12 and IL-23 Side effects are : dental ulceration.
24 Never use Oral steroids in Psoriasis.
122
25.Treatment of pyogenic granuloma Lesion in pregnancy and post partum resolve sponatoulsy
If persist then removal curettage and catherization cryotherapy excision.
26.Herpes simplex virus is commonest cause of Erythema multiforme.
27.Target lesion like bulls eye and symmetrical distribution on dorsal surfaces of extensor extremities is
=Erythema multiforme
DERMATOLOGY PEARLS
Treatment: supportive.
28.Causes of Erythema multiforme are :
Virus herpes simplex virus
Mycoplasma streptococcus
Drugs: Penicillin, sulphonylurea, barbiturates, carbamazepine, Allopurinol, NSAIDS,OCP nevirapine
SLE
IBD
Sarcodosis
Malignancy.
29.Severe macular atypical target lesion mucosal involvement on face and trunk + less than 10% body
involvement+ fever arthralgia is =Steven Johnson syndrome Causes are same as EM.
30.Pyrexia + tachycardia + niklosky sign positive + severe mucocutaneous exfolitive disease is =Toxic
epidermal nacrolysis
Treatment : stop precipating
Iv immunoglobins
Immunosuppressive cyclosporine
cyclophosphamide plasmaphresis
123
31.Causes of Toxic epidermal nacrolysis are :
Viral
Leukaemia
Lymphoma
DERMATOLOGY PEARLS
Drugs.
32.Drugs causing Toxic epidermal nacrolysis are :
Phenytoin
Sulphonamides
Allopurinol
Penicillin
Carbamazepine
Nsaids
33.50-60 years + Diabetic + swollen red warm foot and ankle + high arched foot +
neuropathic + Normal C reactive white cells unlike osteomyelitis is = Charcot foot
Diagnosed by :X-ray Indium labelled white cell scan best way to differentiate Infective
causes.
34.Treatment of Charcot foot Immobilisation in case for 3-6 month Total contact plaster
Bisphosphonates
Surgery
Good blood glucose control.
35.Female 40-60 years +diabetes/DVT + ulcer on medial/lateral malleous which pink
yellow green hair thick hardened +ABPI 0.9+ venous ulcer Treatment: multilayer banding
For banding u need ABI of 0.8
124
36.Male >60years +HTN/DM/ hyperlipidaemia/smoking + severe pain on heel metatarsal
regular deep green absent swelling +ABI <0.75 no hair rubor thin shiny skin is = Arterial
ulcer
37.Causes of scarring alopecia (destruction of hair follicle) are :
Trauma
DERMATOLOGY PEARLS
burns
Radiotherapy
Lichen planus
Discoid lupus
Tinae capitis.
38.Causes of non scarring alopecia (preservation of hair follicle are :
Male pattern baldness
Drugs: cytotoxic drugs , carbimazole,heparin ,OCP colchine Iron zinc defienancy
Alopecia areta
Tolgen effluvium
Trichotillomania
39.Localized patches of nonscarring hair loss + exclamation marks tapered towards base
is = alopecia areta
Treatment: hair will regrow in 50%Topical or intralesional steroids most appropriate
Others topical minoxdil, photo therapy diathronl immunotherapy wig
40.After puberty diffuse slow hair loss with characteristic loss over temporal regions and
vertex in male is = Androgenetic alopecia
125
 41.1 to 3 month after viral illness, surgery, childbirth , emotional stress
diffuse hair loss + hair loss never complete usually stops after 3 to 5
month is = Tolgen effluvium
DERMATOLOGY PEARLS
 Treatment : hair regrowth.
 42.Children + localized hair loss but in bizarre pattern + patient pull
their own hair + hairs of different length is =Trichotillomania
 43.Scarring alopecia + atrophic with visible loss of hair follicle is=Discoid
lupus erythramatous
 44.Permanent bald patches with no visible follicles is = Cicatrical
alopecia Treatment: treatment of underlying cause like (DLE,lichen
palnus ) topical Steriods.
 45.Elderly patient sun exposure + at head and neck pearly flesh
colured papule with telangiectasia ulcerated leaving central crater is =
basal cell carcinoma
 46.Treatment of basal cell carcinoma :
 Surgical removal
 Curettage
 Cryotherapy
 Topical cream : imiquoid fluorouracil Radiotherapy
126
 47.Old patient retired may be builder working in sun exposed areas + small
crusty scaly lesion + pink ,red , brown on temples of head is = Actinic
keratosis/solar keratosis Treatment: prevention : sun avoidance sun cream
 Fluorouracil Topical diclofenac, Topical imiquoid Cryotherapy Curettage and
DERMATOLOGY PEARLS
cautery
 48.Elderly male + scalp forehead pruritic patch or plaques often nodules that
may bleed is = Angiosarcoma
 49.Elderly + stuck on papule or nodule + barnacles of aging + variation in
colour from flesh to light brown to black on chest, back head neck is =
Saeborrhic keratosis/basal cell papilloma
 Treatment : Reassurance Curettage and cautery croyrotherpy for thinner
lesions
 50 Nacrobiasis lipodica and non atrophic skin = Topical steroids
 51.Hyperpigemented scaly lichenified + History of chronic scratching or
manipulation site is ankle is = Lichen simplex chronics.
 52.Uses of narrow band phototherapy are :
 Psoriasis
 Mycosis fungoides patch stage
 Vitiligo
 Eczema
127
 53 Lower limb small red papule deep, red narcotic ulcers violaceous
border serpiginous outline undermined bluish is = pyoderma
gangreosum.
 54 Causes of pyoderma gangreosum are :
DERMATOLOGY PEARLS
 IBD UC> Crohn's
 RA,SLE
 Myeloperlifertive disorders Lymphoma leukaemia
 Monoclonal gammopathy
 PBC.
 55 Treatment of Pyoderma gangreosum is :
 1st line : Oral steroids
 1st confirm pain relief Culture biopsy then oral Prednisolone
 2nd line ciclosporin,infliximab.
 56 10-35 years +Herald patch on trunk + erythematous oval scaly
patches fir tree appearance is = Pityriasis rosea caused by Herpes
hominis virus 7
 Treatment: usually disappears after 4-12 weeks.
128
 57.Patches hypo pigmented pink brown scale on truck in
immunocomprismed /malnutrition is = Pityriasis versicolor (Tinae
versicolor) caused by Melassezia furfur
 Treatment: topical antifungal ketoconazole topical selenium sulphide
DERMATOLOGY PEARLS
Extensive=Oral itraconazole.
 58.Tender erythematous indurated plaque with sharply demarcated
border is = Erysipelas caused by streptococcus pyogens (group A)
 Treatment: Benzylpenicilin if allergic then erythromycin
 Complications are :sepsis, cerebral abscess ,venous sinus thrombosis
 59.Treatment of Eczema :
 Topical steroids :Mild : hydrocortisone
 Moderate : Clobetasone butyrate 0.05%,betamethasone valerate
0.025% (Betnovate BD) Potent: betamethasone valerate
0.1%(Betnovate), Fluticasone propionate
 Very potent : Clobetasone propionate 0.05%.
 60.Inflamed itch crackle rough blisters on neck and face of children
+fever = Eczema Herpticum
 Treatment: acyclovir
129
pHarMaCology & toXICology
PHARMACOLOGY& TOXICOLOGY PEARLS

pearls
• 1. Overdose of benzodiazepines + reduced conscious level
+respiratory depression =intubate and ventilate rather than
flumazenil
• 2.Clozapine not only cause agranulocytosis but also
myocarditis so never forget to do ECG prior to it's use
• 3.. Some clues about poisons :
• ecstasy all hyper except sodium.
• Methotrexate : cerebellar signs
• Cocaine : chest pain , ECG wide QRS .
• Ghb : patient usually in coma and may show some lucid
interval Nexus: nasal pain, tactile sensation increased
130
 4. Drugs causing peripheral neuropathy :VITNAM
 Vincristine
 INH
 TCA
 Nitrofurantoin
 Amiodarone
 Metronidazole
 5.Drugs causing retroperitoneal fibrosis are:
 Bromocriptine
 Beta blockers
 Methlyseriglycide
 6.Drugs causing lymphocytic colitis are :
 PPI
 NSAIDS
 SERTALINE
 7.Osteonecrosis of jaw is well recognised complication of
bisphosphonates therapy
131
• 8.Nsaids:COX-2 selective inhibitor (Celecoxib,rofecoxib)
associated with increased risk of thrombotic risk (MI and
stroke) but associated with lower risk of upper GI side
effects good in ulceration or bleeding
• Non selective Nsaid=also associated with Elevated risk of
thrombotic risk(,diclofenac and ibuprofen) Naproxen has
lower risk of thrombosis hence best choice
• 9.Drugs causing acute dystonia :
• Neuroleptics (Haloperidol,levomepromazine)
• Antiemetic's(metoclopramide)
• Antidepressants (amitriptyline,trazodone)
• Management :stop drug fallowed by either benztropine
or diphenhydaramine , benzodiazepines may be helpful.
132
10.Drug causing Hypertension are :

Steroids
monoamine oxidase inhibitors
the combined oral contraceptive pill
NSAIDs
leflunomide
11.Contraindications of beta blockers :
Heart block
uncontrolled heart failure
Asthma
sick sinus syndrome
concurrent verapamil use: may precipitate severe bradycardia
12.Indication of statin :
Primary prevention:10 years CV risk is 10%or more OR most type 1diabetes Or CKD if GFR
less than 60 give =Atorvastatin 20mg (if non HDL is not fallen by 40% then titrate up to
80mg Atorvastatin
Secondary prevention : known ischemic disease of stroke or peripheral atrial disease give =
Atorvastatin 80mg
13.Treatment of carbon monoxide :
Apply tight fitting non rebreather mask and give 100%oxygen If patient is comatose then
intubation and ventilation with 100% oxygen
133
14.Side effects of statins :

myopathy
myalgia, myositis,
Rhabdomylosis
asymptomatic raised creatinine kinase Myopathy is more common in
(simvastatin, atorvastatin) than (rosuvastatin, pravastatin, fluvastatin).
liver impairment: the 2014 NICE guidelines recommend checking LFTs at
baseline, 3 months and 12 months.
Treatment should be discontinued if serum transaminase concentrations rise to
and persist at 3 times the upper limit of the reference range statins may increase
the risk of intracerebral haemorrhage in patients who've previously had a stroke
avoid in patient with intracerebral haemorrhage
15.Cyclophosphamide Adverse effects :
haemorrhagic cystitis : incidence reduced by the use of hydration and mesna
Myelosuppression
transitional cell carcinoma
16.Treatment of cyclophosphamide induced side effects =Mesna2-
mercaptoethane sulfonate and metabolite of cyclophosphamide called acrolein
is toxic to urothelium mesna binds to and inactivates acrolein helping to prevent
haemorrhagic cystitis
134
17.Phases of drugs Phase I =studies study safety = phramcokinetics,phramcodymanics first
usage in human subjects.
Phase II=studies are designed to elucidate any therapeutic response in specific settings
combined with phase I .
Phase III =Performed once initial safety and efficacy evaluation is completed , compare the
drug with alternative.
18.Side effects of Ketamine are :
Raised intracranial pressure i.e. headache, papilloedema,vomiting
Hypertension
Hallucinations
Bladder and liver dysfunction
19. Side effects of Exogenous androgens are :
Acne
Gynaecomastia
Hypertension
Hypercholesterolemia
Hepatic tumours
Paranoid delusions
20.Opiates safe in renal impairment are :
Fentanyl
Buprenorphine
Methadone
135
 21.Drugs altering absorption or clearance of Thyroid :
 Cholestrayamine
 Ferrous sulphate
 Lovastatin
 Aluminium hydroxide
 Rifampicin
 Amiodarone
 Carbamazepine
 Phenytoin
 22.Drugs causing thrombocytopenia
 Quinine
 Diuretics
 Sulphonamides
 Aspirin
 Thiazides
 Pseudo thrombocytopenia occurs with use of EDTA Thrombocypenia occurs on
7day of transplant unlike graft VS host diseases which occur after 2 weeks
 23 Carboxyheamoglobin cohb is best for prognosis in carbon monoxide
poisoning
136
24.Contraindictions to metformin :

Renal failure
hepatic failure
heart failure lactic acidosis
CKD review when Cr>130 Stop when >150 or GFR less than 30 Recent MI within 6 weeks Alcohol
use,IV contrast angiography.
25. side affects of sulphonylurea are :
Hypoglycaemia
Weight gain
SIADH
Liver damage
Photosensitive
Haemolytic anaemia G6PD
26 Side effects of GLP 1 Extentide is :
Severe pancreatitis
Renal impairment
27.Side effects of DPP-,4 inhibitor Gliptin :
Git disturbance nausea
diarrhoea
constipation
Little Pancreatitis
28.Side effects of SGLT2 inhibitor :
canagliflozin
depagliflozin empagliflozin Genital infection Flucytosine,DKA Hypoglycaemia UTI
137
 29.SGLT-2 batter in HTN and cardiovascular disease in diabetes

mellitus
 30. Drugs causing photoxiocity are :
 Antibiotics:tetracyclines,fluroquinolones,sulphonamides Nsaids
 Diuretics :furosemide,bumetanide Sulphonylurea
 Neuroleptics : chlorpromazine Antifungals:terbinafine ,itraconazole
 Other drugs : Amiodarone diltizem
 31.In cases of severe theophylline toxicity ,charcoal haemoperfusion
can be used.
 32.Acidosis + hypokelmia + vomiting + tachycardia arrhythmias +
seizures is = Theophylline toxicity
 Treatment : gastric lavage if <1 he prior to ingestion
 Activated charcoal
 Whole bowel irrigation if Theophylline is sustained release forum
 Charcoal haemoperfusion is preferable to haemodialysis
138
 33.Dry cough + dilated pupil + agitation+ sinus tachycardia + blurred

vision + arrthymais, + seizures + 3 Cs convuslion,coma , Cardio toxicity
+ on ECG sinus tachycardia widening QRS,prolonged QT is = TCA
poisoning (amitriptyline,Dosulepisn)
 QRS >100=seizures
 QRS >160= Ventricular arrhythmias
 34.Treatment of TCA poisoning :
 Mainstay :I/V bicarbonate reduce acidosis Don't use
Quindine,flecainde Amiodarone
 Gastric lavage =1 hour of ingestion Charcoal 2hr ingestion if GCS is not
reduced IV lipid emulsion Dialysis is not effective in TCA.
 35.Most appropriate intervention in lead poisoning is DMSA
 36.Mixed sensorimotor polyneuropathy + pesticides in farmer +
nausea, vomiting gastroenteritis garlic breath coma seizures+ mees
lines + abdominal pain + peripheral neuropathy is = Arsenic poisoning
 Treatment : DMSA (sucimer) penicillamine.
139
 37.Agitiation + confusion + sleepiness lasting up to 24 hours or more + pupils

dilated and unreactive to light + visual and auditory hallucinations is =
Procylidine poisoning used to treat parkinsonian side effects of neuroleptics.
 38.Hypokelmic alkalosis + high urine potassium + athletes is = Diuretics abuse.
 39.Farmer + pesticides + DUMBLESS : Diarrhoea,urination,miosis, bradycardia/
bronchospasm,lacrimation,emesis,salivation,sweating , hypotension, twitching
fasciculation's, muscle weakness tremor hyperreflexia is =
Oragnophosphorous poisoning (Malathion, parathion)
 Treatment:Atropine,pralidoxime
 40.Alcohol abuser + nausea vomiting headache confusion early + high anion
gap Metabolic acidosis + retinal injury visual problems with blindness optic
neuropathy macular edema is = Methanol toxicity.
 41.Treatment of methanol poisoning :
 1st line : Femipizole inhibit alcohol dehydrogenase
 2nd line : if Femipizole not available ethanol (it competes with alcohol
dehydrogenase
 Na bicarbonate if PH <7.2
 Folic acid to reduce eye symptoms
 Haemodialysis
140
 42.Indications of haemodialysis in methanol toxicity:
 Worsening acidosis despite Na bicarbonate
 Visual problems
 Consumer exceeds 30ml Methanol level >20.
 43.Antifreeze used for suicide + stage 1 confusion ,slurred
speech ,dizziness 2nd stage metabolic acidosis with high
anion gap, tachycardia Hypertension stage 3 renal failure,
respiratory, cardiac failure , oxalate stone symptoms like
alcohol is = Ethylene poisoning
 Treatment: 1st: Femipizole
 2nd line : ethanol
 In severe acidosis : Give fluids with bicarbonate
 Haemodialysis refractory cases.
 44.Oxalte stones = Ethylene poisoning
 Eye problems = Methanol poisoning
141
45.Protamine sulphate is antidote for heparin.
46.Warfarin has narrow therapeutic index affected by drugs like SSRI Sertraline and citalopram are safest
antidepressants with warfarin.
47.Inhibitor of 450 = decease serum level and causes toxicity SICKFACES.COMS:
sodium valproate / SSRII:
Isoniazid
C: Ciprofloxacin
K:Ketoconazole
F: Fluconazole
A:alchol(acute)/amiodarone
C: Cimetidine
E:Erythromycin
S: sulphonamides
C: chloramphenicol
O: Omeprazole
M: Metronidazole
Others: Grape juice ,navir, Disulfiram, quinpristin.
48.Inducer of p450
CRAP GPSC: Carbamazepine
R: Rifampicin
A:alchol(chronic)
P: phenytoin
G:Grieflvin
P: Phenobarbitone
S:St John's wart
Smokers
142
 49.3-7 days after cessation of alcohol ingestion + visual
hallucinations + autonomic instability (tachycardia,
Hypertension and fever) + obtundation confusion +
sweating , tremor's agitation is = Delirium tremens
 Treatment: benzodiazepines
 50.Diaphoresis,shaking, cramping,agiation , Diarrhoea
 but no autonomic instability and hallucinations is =
Opiate withdrawal.
 51.Elevation transaminases more than 100 times upper
limit of normal is seen in :
 ischemic Hepatitis
 paracetamol overdose.
 52.Co-adminstration of aminophylline and ciprofloxacin
can cause toxicity and macrolides hence avoided
143
53.Dance (club ) active guy + agitation anxiety confusion ataxia + tachycardia +

Hypertension + hyponatremia + hyperventilation + hyperthermia + Rhabdomylosis
+ blurred vision + acute renal failure+ DIC + ARDs + hyperkalaemia is = Ecstasy
(MDM 3,4 methlynediomethamphetamine ) poisoning
Associated with Serotonin syndrome.
54.Treatment of Ecstasy poisoning :
I/V fluid if temperature >39 Dantrolene if simple measure fail Paralysis ventilation.
55.Poor prognostic factors in Ecstasy poisoning :
Fever >42
Rhabdomylosis
Renal failure,
liver failure
HTN
DIC
56.Drugs treatment for acute dystonia dyskinesia reactions :
I/V benztropine
Procylidine
Antihistamine diphenhydaramine.
57.Lathergy ,anorexia + nausea vomiting diarrhoea confusion + yellow green vision
+ arrthymais AV block is = Digoxin toxicity
144
58.Precipating factors for digoxin toxicity :
Low k
Low mg
Low PH
Low temperature.
Low albumin
Hypothyroidism
Increasing age
Renal failure
High sodium
Myocardial ischemia.
59.Drugs causing digoxin toxicity:
Quinidine
Verapamil and diltizem but not amlodipine
Spironolactone
Thiazides
Furosemide
Amiodarone
Cyclosporine
Cholestrayamine
colpestol decrease level
60.Treatment of digoxin toxicity
KLAM
Slowly normalize K
Lidocaine ,phenytoin
Digoxin antibody Mg(avoid in bradycardia)
145
pSYCHITArY pEArLS
• 1..Flight of ideas + pressure speech + grandiose delusions +
PSYCHITARY PEARLS
elevated mood is = Mania
• Treatment is lithium, sodium valproate ,carbamazepine
• 2.Mania and hypomania is differentiate by presence of delusion of
grandeur and auditory hallucination in mania not hypomania
• 3.Major disaster, childhood sexual abuse + re-experiencing
flashbacks, nightmares, repetitive distressing images, avoiding
people or circumstances resembling event is =post traumatic stress
disorder
• 4.Winter season + hyperphagia + hyper insomnia + weight gain is
=seasonal affective disorder
• Treatment expose patient to light for few hours of day
• 5 .Insomnia + tremor + loss of appetite + perspiration + tinnitus+
seizures anxiety is= benzodiazepine withdrawal syndrome
146
 6.Depression +high mood is =cyclothymia
 7.Chronic depression +sleep badly, and feel inadequate is=dysthymia
 8.Techycardia+HTN + pyrexia + visual hallucinations + agitation is = delirium
tremens
 9 .Treatment of alcohol withdrawal is = benzodiazepines Lorazapam
 For abstinence = Disulfiram
PSYCHITARY PEARLS
 To reduces craving= Acamprosate
 To reduces pleasure that alcohol brings and craving= Naltrexone
 10.. 12 to 24 Hours after alcohol withdrawal + visual auditory, tactile
hallucinations is = Alcoholic hallucinosis
 11.. Impairment in consciousness + nocturnal worsening + intact memory for
recent + visual hallucinations is = delirium
 12.Fixed ,false, firmly held belief out of keeping with persons social and
cultural background is= delusion Belief of exaggerated importance and often
occur in mania = grandiose delusions
 13.Misperception of stimuli is =illusion
 14.Fear of open spaces , crowds + patient can go outside for years is =
Agoraphobia
 15 .Specific phobia or fear of heights is = acrophobia
147
16.Lab in Anorexia Nervosa Most things Low except:
3Gs and 3Cs which are high Growth hormone Glucose Salivary Glands
Cortisol Cholesterol Carotinemia High amylase
17.Features of anorexia Nervosa :
PSYCHITARY PEARLS
BMI <17.5 Amenorrhea
Hyponatremia
Hypokelmia
Hypocalcaemia
Low FSH LH oestrogens but normal testosterone
Ferritin low Normocytic anaemia Lanugo hairs
18.Underweight + hypokalaemia + normal BP + calluses on knuckles + low
urinary potassium is = Laxative abuse from bulimia
19. 1-6 Mon duration + delusions + hallucinations + disorganized
thought and speech + negative symptoms = Schizophreniform disorder.
20.Paranoid schizophrenia prominent hallucinations and delusional
ideations with preservation of affect and cognitive functions
148
21.Delirium believe that some one poison him
or nurse is trying to get him out of ward 1st
treated but 1:1 nursing in safe environment
Haloperidol and Lorazapam is used for delirium
PSYCHITARY PEARLS
.Olanzapine and resperidone causes
Cerebrovascular disease hence avoided in
elderly.
22.Nacrolepsy treated by = Methylphenidate
23.Cateplexy = Clomipramine and fluoxetine
24.Manic episode + risk to herself give = IM
Lorazapam sedation If not available then
Haloperidol.
149
 25.He said he is Jesus because God spoke to him through TV is = Acute
psychosis which may be related to underlying primary schizophrenia
 26.Treatment of acute psychosis is : resperidone
 27.False beliefs that she some one trying to harm her she is afraid
that they see her and will hurt her she has proves of it like they keep
PSYCHITARY PEARLS
garbage outside to trap her
 Other example is feelings insects crawling over skin = delusions (false
believe)
 28.She laughs and giggles for apparent reason and she is unable to
dress or shower herself ,rocking muttering softly herself =
Schizophrenia in disorganized type.
 29.Unable to eat or drink anything unresponsive both vocally and
nonverbally she resist any attempt to be moved socially isolated
bizarre and speak people no one else could see = Cationic
schizophrenia.
 30.He has not slept ,bathed ,eaten lack of personal care, in talks to
himself hallucinations is and he says some one stealing his thoughts he
fallow making him unable do school material he is crying feeling of
suicide is = Schizoaffective disorder
150
31.Hallucinatory voices commanding him to do
things hum or laugh + delusions like girl friend
wants to leave him and he has illness and won't
live more than 1 year+ hallucinations of smell
PSYCHITARY PEARLS
i.e. he smell of fish + neglect personal hygiene =
Paranoid schizophrenia.
32.Side effects of Exogenous androgen is
paranoid delusions and aggressive behaviour.
33.Sertraline and citalopram appear be safest
with antidepressants with Warfarin.
34.Alzheimer's + psychic features like slapping
his wife and inhibitor = give antipsychotics like
olanzapine
151
 35. Abnormal clock drawing test in dementia differentiate it
from delirium.
 36.Ropinirole D2/D3 dopamine agonist is associated with
changes in behaviour like gambling high risk sexual
intercourse
PSYCHITARY PEARLS
 37.Drugs causing Euphoria:
 MDMA
 Amphetamines
 Cocaine
 Mephrodone
 38.Delirium is treated by Haloperidol , Lorazapam Nursing
safe environment
 39.Alochol withdrawal = benzodiazepines
 40.Disulfiram promotes abstinence but contraindicated in
ischemic heart disease and psychosis
 41.Acromprostate reduces craving weak antagonist of NMDP
152
 42.Aggressive behaviour + sweating + Hypertension + tachycardia is =
delirium tremens
 43.Treatment : benzodiazepines diazepam.
 44.1st line in obsessive compulsive disorder is CBT if resistant then
PSYCHITARY PEARLS
SSRI
 45.Preserved awareness + visual attention tracking patients appear
that they are about to speak but don't = akinetic mutasim
 46.He believed that flickering lights were transmitting messages to
him as new Messiah .believed that red car had passed him that
morning an epic battle with devil is pending is = psychotic delusions
of reference typical feature of Schizophreniform
 47.Treatment 1st line resperidone
 48.Drinks alcohol daily + sweaty agitated + tells u that nurses are
trying to poison her but she trusts u is = Alcohol withdrawal syndrome
 49 treatment : give Chlordiazepoxide not resperidone
153
 50.Impulsive behaviour + repeated self harming over
reaction to minor events accompanied by feelings of
emptiness =Borderline personality
 51.Alchol withdrawal = Lorazapam
 52.Sczhioperhnia (delusions, hallucinations, disorganized
PSYCHITARY PEARLS
speech or behaviour negative symptoms of at least 6 min
with at least 1 month of active symptoms ) + major
depressive episode or manic episode like u believe that
there is devil who wants to kill her hence she wants to kill
herself is= Schizoaffective disorder
 53.Antipyschotic causes skin rash pigmentation is
chlorpromazine
 54.Side effects of Atypical antipsychotics is =
Hyperglycaemia
 Haloperidol = hypoglycaemia
 Phenelzine = dry mouth constipation
154
55.Psychiatric (anxiety, mood liability ,vivid
dreams) + GI nausea vomiting + dizziness
headache paraesthesia dystonia tremor is =
PSYCHITARY PEARLS
SSRI discontinuation syndrome.
56.Hallucinatory voices commanding him to do
things or non-verbal forms such as humming or
laughing + delusions which may be jealousy
theme or bodily change + hallucinations of
smell is= paranoid schizophrenia
57.Quetapine used for dopaminergic induced
psychosis and hallucinations
155
 58.Low mood + worry sadness anxiety poor
concentration insomnia following recent stressful
occurrence + loss of pet is = adjustment disorder
 59. treatment of Adjustment disorder is :
PSYCHITARY PEARLS
 psychotherapy
 SSRI
 59.No low mood in generalized anxiety disorder.
 60.Schzhioaffective disorder has features of both
mood disorder and schizophrenia including
psychomotor retardation features of depression
hallucinations and delusion
156
ONCOLOGY pEArLS
 1. Testicular lump + mass on chest X-ray + raised beta HCG = Testicular
seminoma.
 Treatment is = Chemotherapy + Orchiectomy
ONCOLOGY PEARLS
 2.Dyspanae + swelling of face,neck ,forarm,headache + JVP raised + visual
disturbance + fixed dilated neck veins is = Superior vena cava obstruction
 3.Investigation of choice For Superior vena cava obstruction is = Ct guided
biopsy of mediastinal mass
 4.Treatment of superior vena cava obstruction :
 General: Dexamethasone treating underlying cause
 In some cases of no small cell carcinoma stenting is required before
chemotherapy and radiotherapy
 5.Investigation in breast cancer:
 Screening : Mammograms sensitive in older not in younger
 BRCA-1 orBRCA-2 mutation screening
 Breast MRI
 Tumour markers:CA15-3
157
• 6. 30-40 years + painless + small non palpable mass or hard
testis + symptoms of metastasis + gynaecomastia + markedly
raise Beta HCG and AFP + on ultrasound
heamorrgaes,necrosis,cystic calcified = Choriocarcinoma
• 7.Chemotherapy used in testicular cancer
ONCOLOGY PEARLS
• B= bleomycin
• E= etoposide
• P= cisplatin (platinum)
• 8.Papillary thyroid cancer is treated by =Thyroidectomy
followed by Radioiodine -131 therapy
• 9.High Alpha fetoprotein + high beta HCG = Nonseminoma
• 10.High beta HCG not AFP is = Seminoma
• 11.Radical orchiectomy is required for definitive histological
staging and treatment fallowed by additional staging studies
such as Ct scan of abdomen and pelvis and radiographs of
chest in testicular cancer.
158
 12.Horseness+odynophagia + ulcerated lesion projecting from vocal
card friable with bleeding = Squamous cell laryngeal carcinoma
 Treatment: stage II external beam radiation
 13.Hesitancy,urinary retention + heamaturia,haematospermia + back
ONCOLOGY PEARLS
pain / perineal , testicular pain + peripheral zone + asymmetrical hard
nodular enlargement with loss of median sulcus is = Prostatic cancer
 14.Treatment of prostate cancer:
 Localized T1/T2 palpable disease confined to prostate = Conservative,
radical prostectomy , radiotherapy: external beam and brachytherapy
 Localized advanced T3/T4 beyond capsule, bladder neck or rectum =
Hormonal therapy ,radical prostectomy, radiotherapy external beam
and brachytherapy
 Metastatic = hormonal synthetic GnRH agonist : Goserlin luprolide
 Anti androgen = Crproteron acetate Orchidectomy
 15.Trial of sildenafil is appropriate unless contraindicated for erectile
dysfunction regardless of underlying aetiology
159
16.Back pain worse on lying down or coughing + lower limb weakness + sensory
loss and numbness + lesion above L1 UMN signs in legs and sensory level lesion
below L1 LMN signs in legs and perianal lesion = spinal cord compression
17.Investigation of choice for Spinal cord compression is = MRI whole spine
ONCOLOGY PEARLS
18.Treatment for spinal cord compression is =
High dose dexamethasone
Radiotherapy surgery
CNS features=surgery
19.Risk factors for breast cancer:
BRCA-1 or BRCA-2
Early menarche
Late menopause
Nullparity
OCP
20. Treatment of colon cancer Stage 1 and stage II good risk = Observation
Stage III LN involvement = Surgery + chemotherapy
No role radiotherapy in colon cancer unlike rectal cancer
160
 21.Treatment of small cell lung carcinoma :
 Chemotherapy
 Prophylactic cranial radiation (brain is frequent site of first relapse after
complete therapeutic response)
 No role of surgery
ONCOLOGY PEARLS
 22.Surgery in breast cancer
 Indications of mastectomy:
 i) Multifocal tumour
 ii) central tumour
 iii)large lesion in small breast
 iv) DCIS more than 4 cm Indications of wide local excision:
 i) solitary lesion
 ii) peripheral lesion
 iii)small lesion in large breast
 iv) DCIS less than 4cm Radiotherapy adjuvant given after surgery to prevent
recurrence
 23.Lower back/ flank pain + fever + lower limb oedema + haematuria +
Bromocriptine is= retroperitoneal fibrosis
161
 24.Treatment of Colorectal cancer:
 Stage I (Duke A) mucosal or sub mucosa treatment : Surgery
 Stage II(Duke B) extends into muscularis ,into or through serosa
treatment : Surgery fallowed by radiotherapy
 Stage III(Dukes C) extends to regional lymph nodes treatment : Surgery
ONCOLOGY PEARLS
+ Chemotherapy with 5FU and leucovorin and in some patients
radiotherapy (large tumour or invading tissues)
 Stage IV (Dukes D) metastasized to distant sites treatment : surgery ,
palltive chemotherapy and or radiotherapy chemotherapy:Cetuximab
or becavizumab
 25.Debulking surgery fallowed by chemotherapy is best treatment
option for patients with peritoneal carcinomatosis from ovarian cancer
 26. Nice guidelines on Metastatic malignant diseases of unknown
primary origin recommends that if simple initial investigation fail to
indicate a site for further investigation of malignancy of unknown
origin then a CT chest, abdomen and pelvis should be performed
 27.Dermtomyocitis is associated with which cancers = breast,lung,git
and pancreatic cancer
162
 28.Management of breast cancer:
 Drug therapy Hormonal therapy : Premenopausal =Tomoxifen
blocking oestrogen receptors Side effects : vaginal bleeding,
endometrial cancer, thromboembolism
 Postmenopausal : aromatase inhibitor : preventing conversion
ONCOLOGY PEARLS
of oestrogen : Anastrole(1st
line),exemestane,letrozole,fulvestrant Side effects
:osteoporosis ,fragility fracture do Dexa scan Bone disease =
bisphosphonates zoledronic acid 1st lineHer2/neu (c- erb B2)
positive =Trastuzumab SE Cardiomyopathy so do ECHO
 29.Typhiltis or Neutropenic colitis is serious complication of
Neutropenia
 30.Cetuximab k-ras wild type is used in metastatic colorectal
cancer Side effects : acne type rash
 31 HNPCC is associated with increased risk of ovarian cancer
 34 Ovarian cancer treated by = 1st line carboplatin and
paclitaxel combination 2nd line liposomal doxorubicin (caelyx)
163
35. AFP + beta HCG + PLAP(placental like isoenzyme of alkaline phosphatase)
used for testicular teratoma
36 Tumour antigens :
PSA = prostatic cancer
AFP=Hepatocellular carcinoma, teratoma, Nonseminoma
CEA=colorectal cancer
ONCOLOGY PEARLS
S-100 = melanoma,schwanomas
Bombesin = small cell lung carcinoma, gastric carcinoma, neuroblastoma
Beta HCG = choricocarinoma,germ cell tumours lung cancer
37.Tumor markers :
CA-125 = ovarian cancer
CA19-9= pancreatic cancer
CA 15-3=breast cancer
CEA=colorectal cancer
38.Primary tumours most frequently associated with metastatic spread to brain
are :
Lung cancer
Breast cancer
Malignant melanoma melanoma causes multiple metastasis where as breast
causes solitary brain lesion steroids and palliation initial treatment
164
39.Cancer pain management WHO analgesic ladder as follows:
Step 1-Non-opiod +/-adjuvants (paracetamol/ Nsaids)
Step-2 weak opioid (codeine)+non opioid +/-adjuvants (co-
codamol30/500)
Step3- strong opioid + non opioid +-/adjuvant (morphine, fentanyl,
ONCOLOGY PEARLS
oxycodone)
40.Cancer drug causing itching is =Morphine
41 For bone metastasis following can be done:
Nsaid
Iv bisphosphonates
Surgery
Radiotherapy
41.Levomepromazine is called as Dirty drug because it blocks all receptors
ACh,DA,5HT broad spectrum antiemetic used as 1st line in last days of life
42 Constipated induced vomiting is treated by metoclopramide
,domperidone
43.Chemotherapy induced vomiting and nausea treated by=cyclize,
haloperidol
165
 44.Harmonal management of breast cancer: Tomoxifen
=partial agonist and antagonist of oestrogen .it is 1st line in
premenopausal women DVT is major
 Side effects : Anstrazole,exemestane are aromatase inhibitor
= used in post menopausal women
ONCOLOGY PEARLS
 Fulvestrant = selective oestrogen receptor down regulator
only agent used IV
 45.Morphine is contraindicated in renal failure
 46. fentanyl can be given in renal impairment.
 47.Opiod used in renal failure is Fentanyl (selective u receptor
agonist)
 48.Morphine causes renal impairment.
 49.1st line antiemetic in opioid induced nausea
is=Haloperidol
 50.1st line for breathlessness in palltive care is = opioid
(morphine)
166
 51.Side effects of opioids :
 Constipation
 Meiosis
 Nausea, vomiting
 Urinary retention
ONCOLOGY PEARLS
 Hallucinations
 Myoclonus
 Delirium
 52. Drug used for constipation in palliative care=polyethylene glycol (Movicol)
 53.Lyphmodema in cancer patient is treated by =Skin care and compression
bandaging
 54.Treatment of agitation and confusion in terminal phase:1st line Assess for
urinary retention and consider catheterization if that's trigger Drug :
midazolam
 55. 1st line drug in treatment of agitation and confusion without terminal
stage is =Haloperidol
 56 Treatment of liver capsule pain secondary to liver metastases is
dexamethasone ( April 2019 part -2)
167
57.Antiemetic in palliative care :
Cyclizine = it target dopamine and cholinergic receptor's used in nausea
associated with cerebral diseases (brain Mets) (march 2019 part-2)
Metoclopramide = prokinetic targets dopamine and serotonin used in delayed
gastric emptying a
ONCOLOGY PEARLS
post chemotherapy, Haloperidol= hits dopamine reception used in toxic (opioid)
or metabolic induced nausea
Levomepromazine = hits all receptors used in terminal stage
58 Cancer causing hypercalcemia are :
Lung cancer
Breast cancer
Renal cell cancer
Multiple myeloma
59 Electrolyte disturbance in refeeding syndrome :
Low P
Low mg
Low K
60 Indication of blood transfusion in palliative care is = disabling shortness of
breath on maximal excretion
168
OpHTHALMOLOGY pEArLS
OPHTHALMOLOGY PEARLS
 1. MS/DM/ syphilis + Unilateral decrease in visual acuity + poor
decrimnation of colours + pain worse on eye movement + relative afferent
pupillary defect + central sctoma is= optic neuritis
 Treatment is with steroids
 2.Resfum disease /alport syndrome/Kearns Sayre syndrome + Night
blindness + tunnel vision + black bone spicule shaped pigmentation is
=Retinitis pigmentosa
 3. MS/ sarcodosis /DM + Small pupil + accommodation reflex present but
pupillary reflex absent is Argyll Robertson pupil
 4.. Dilated pupil + absent leg reflexes + slowly reactive to near
/accommodation reflex +poor response to light is= Holmes Adie pupil
 Diagnostic test is weak pilocarpine
 5..Eye is deviated down and out + ptosis + dilated pupil + unreactive pupil
to light + pain if posterior communicating artery aneurysm is=Third nerve
palsy
169
 6. Vesicular rash around eyes + Hutchinson sign i.e. rash on tip or side
of nose is=herpes zoster ophthalmicus
 Treatment is oral antiviral ,oral steroids
 7.. Red painful eye + photophobia + ephiphora + visual acuity
decreased+ Fluorescein staining show epithelial ulcer with dendritic
pattern is = Herpes simplex keratitis
 Treatment is topical acyclovir Never steroids
 8.Nystagmus+ophthalmoplegia+ataxia+alchlocs+ confusion +
peripheral sensory neuropathy + decrease red cell transketolase is=
Wernicke's encephalopathy
 Treatment is thiamine
 9. Optic atrophy + contralateral papilledema + anosmia is=Foster
Kennedy syndrome
 10. Marfan's syndrome has upward lens dislocation supratentorial
ectopia lentis
 11.Homocystinuria downward inferonasal dislocation of lens
170
12.Sudden deterioration in vision and flame
haemorrhages in one quadrant is branch retinal
vein occlusion
13.Central vein occlusion involve flame
haemorrhages in all four quadrants
14.Eye disease seen in alport syndrome is =
Astigmatism
15.Young man + painless loss of vision + visual
acuity fails to improve is = Laber's optic
neuropathy
171
 16. optic nerve drusen + progressive loss of visual perception,
 coupled with drusen + geographic atrophy (larger areas of retinal
pigment loss) = Macular degeneration.
 17.investigation of macular degeneration is = Optical coherence
tomography is used to support the initial diagnosis and to assess
severity of disease.
 18.Treatment : Anti-VEGF therapies are the cornerstone of the
treatment of wet age related macular degeneration to
 prevent / delay further neovascularisation.
 19.Glaucoma is associated with enlargement of the blind spot,
blurring of the margins of the optic disc and raised intra-ocular
pressure.
 20.Severe hypertensive retinopathy is associated with retinal
haemorrhages.
 21.Retinitis pigmentosa presents initially with loss of night vision, at a
much earlier age than 74.
 22.Ischaemic optic neuritis associated with pale swollen optic disc.
172
• 23.Optic neuropathy + proptosis + chemosis +
opthalmoplegia (sixth nerve palsy )+ blurred
vision ptosis pale optic disk corneal reflex lost is
= Orbital Apex syndrome
• 24.Dilated pupil + slowly responsive to light but
reacts normally to accommodation + loss of
reflex = Holmes Adie pupil
• 25.Branch retinal vein occlusion where there is
arc of haemorrhages treated by Ranibizumab.
• 26.In central retinal artery occlusion give intra
arterial thrombolysis
173
27.Optic neuritis is painful visual acuity
improves in week.
28.Homonymous hemianopia + afferent
pupillary defect + optic pallor + angiod streaks +
yellow papules on neck + seizures + memory
deficit + MRI shows bilateral infarcts in right
parieto-occpital area visual field defect is =
Pseudoxanthoma elasticum
29.Vigabatrin causes visual field loss blurred
vision ,ocilospia tunnel vision.
174
30.Homonymous hemianopia with macula
sparing lesion at = Occipital lobe.
31.Contralateral homonymous inferior
quadrantanopia lesion at = parietal lobe.
32. Contralateral homonymous superior
quadrantanopia lesion at = temporal lobe.
33.Bitemporal hemianopia lesion at = optic
chiasm
175
 34.Sudden painless deterioration in vision coupled with
pale retina cherry red spot at centre of macula is = CRAO
 35.Eye pain eye red with ciliary flush and firm due to
raised intraocular pressure is = acute glaucoma
 36.Eye pain gradual deterioration in vision,color vision
either normal optic disc or evidence of optic disc
swelling is = acute optic neuritis
 37.Myopia + sudden appearance of floaters flashes
decreased visual acuity is = retinal detachment
 38.Retinal tears and holes treated by croyrotherpy or
laser photocoagulation.
 39.Floaters+myopia+no deterioration in vision and
flashes unlike retinal detachment is = vitreous
detachment
176
 40.Friedreich ataxia = optic atrophy
 41.Refsum disease = retinitis pigmentosa
 42.Differential diagnosis of headache + painful diplopia are :
 Posterior communicating artery aneurysm
 Opthalmogic migraine
 Pituitary adenoma
 Cavernous sinus thrombosis
 Medical mononeuritis
 43.optic atrophy ipsilateral eye + papilledema in contralateral
eye + central sctoma in ipsilateral + Anosmia is = Foster
Kennedy Syndrome frontal lobe
 44.Ipislteral fixed dilated pupil (3rd nerve )+ contralateral
paralysis due to compression of cerebral pundcle is = Uncal
herniation
177
45.Left homonymous hemianopia + afferent
pupillary defect + optic pallor + angiod streaks
+ yellow papules on neck + seizures + mental
disturbance is = Pseudoxanthoma elasticum
46.Mri :bilateral infarcts on right parieto-
occpital area
47.family history/ black patient /Hypertension
/Myopia/ DM + asymptomatic peripheral visual
loss nasal sctoma loss of nasal visual field +
tunnel decrease visual acuity + optic disc
cupping is = primary open angle glaucoma
Treatment is = lantoprost 1st line
178
48.Eye deviated down and out + ptosis + Mydriasis + unreactive pupil to light is = third
nerve palsy
49. Causes of Third Nerve palsy are :
Diabetes mellitus
Vasculitis.
50.Painful or headache + third nerve palsy + menigism is = posterior communicating
artery aneurysm
51.Ptosis + meiosis = Horner syndrome
52.Ptosis + Mydriasis = third nerve palsy
53.Causes of bilateral ptosis are :
Myotonic dystrophy
Myasthenia gravis
Syphilis Congenital
54.Severe pain ocular headache + decrease visual acuity + symptoms worse with
Mydriasis watching TV dark room + myadroatic drop causes it + Hard red eye + halos
around light + semi dilated non reactive pupil +eye ball hard to palpate + hypermetropia
is = acute angle closure glaucoma
55.acute glaucoma is diagnosed by : ganiscope
56. treatment of acute glaucoma is :
IV analgesia,
Antiemetic
topical pilocarpine
Acetazolamide IV + pilocarpine
179
 57.Night blindness initial sign + tunnel vision + black spicule shaped
pigmentation in peripheral retina mottling of retinal pigment is =
Retinitis pigmentosa
 58 Causes of Retinitis pigmentosa are :
 Refsum's disease
 usher Syndrome
 Abetalipoproteinaemia
 Lawrence moon bedi syndrome
 Kearns Sayre syndrome
 Alport syndrome
 59.Unilateral decrease in visual acuity over hours and days + poor
discrimination of colures white red looks paler to on eye than others +
relative afferent papillary defect + central sctoma + accommodation
normal + light reaction is diminished +no sudden loss of vision + no
abnormalities on Fundoscopy retro bulbar is = optic neuritis
 Diagnosed by MRI of brain
 60 Treatment of Optic Neuritis is : IV methylpredinsone
180
IMMuNology
IMMUNOLOGY PEARLS
1.Recurent chest infections + bronchitis + sinusitis + otitis media + atopic
disorder asthma + atopic dermatitis + risk of transfusion risk + coeliac disease
is = Selective immunoglobins
2.Recurent pneumonia + abscesses by (staphylococcus areus,fungi
(Aspergilus) + negative nitroblue tetrazolium test + Abnormal
dihydrohodamine flow cytometry is = Chronic granulomatous disease Due to
lack of NADPH oxidase
3.Partial albinism +peripheral neuropathy + recurrent bacterial infections +
giant granules in neutrophils and platelets = Chediak higashi syndrome
4.Due to microtubule polymerization defect lead to decrease in phagocytosis
4.Recurent bacterial infections + delay in umbilical cord sloughing +absence of
neutrophils pus at sites of infection is = Leukocyte adhesion defiency Due to
defect in LFA-1 integrin CD18 protein on neutrophils
5.Neutrophils disorders are :
C = chronic granulomatosis disease
C= chediak higashi syndrome
L=Leukocyte adhesion defiency
181
 6.Autoimmune disorder + lymphoma +
hypogammaglobulinemia is = Common variable
immuno defiency
IMMUNOLOGY PEARLS
 7.B -Cell disorders
 B =Brutons congenital agammaglobuminia
 C=Common variable immuno defiency
 S=Selective immunoglobins A defiency
 8.Tetralogy of fallot + learning difficulties +
Hypocalcaemia + recurrent viral/fungal disease +
cleft plate is = Digeorge
syndrome22q11.2deltion failure to develop 3rd,4th
pharyngeal pouches.
 9.T-cell disorder = Digeorge syndrome
182
 10.Treatment of hereditary angioedema is =
Transexamic acid
 Danzol
IMMUNOLOGY PEARLS
 anabolic steroids are used for short term and long
term prophylaxis
 Acute : IV C1-inhibitor concentrate and FFP if this is
not available
 11.Painful macular rash + painless non pruritic
swelling of subcutaneous / sub mucosal tissues +
abdominal pain + No urticaria + low level of C1-INH
is = Hereditary angioedema
 12.Serum C4 is most reliable and widely used
screening tool for hereditary angioedema
183
 13.Low IgG low igA + respiratory and GIT infections is =
Common variable immuno defiency
 Treatment is : immunoglobins replacement
IMMUNOLOGY PEARLS
 14.Indications of immunoglobins are :
 Primary and secondary immuno defiency ITP
 Myasthenia gravis
 GBS
 Kawasaki disease
 Toxic epidermal nacrolysis
 Pneumonitis by CMV
 Low serum IgG fallowing stem cell transplant for
malignancy
 Dermatomyositis
 CIDP
184
 15.recurrent bacterial infections ( chest ) + eczema +
thrombocytopenia is = Wiskott-Aldrich syndrome
IMMUNOLOGY PEARLS
 16. Cell Mediated Immune Response – stimulates
production of Interferon Gamma, Tumour Necrosis
Factor Beta and IL 12 which in turn induces cytotoxic T
cell response and eliminated intracellular
organism such as Listeria
 17. Acute Rejection - occurs within weeks of

transplantation and primarily mediated by host T
lymphocytes that act against donor MHC antigens. To
prevent, administer Calcineurin Inhibitor
such as Cyclosporine
185
 18.Hyperacute Rejection – that occurs immediately
due to Preformed Antibodies within the
IMMUNOLOGY PEARLS
recipient. This is a Type II Hypersensitivity Reaction.
 19. Natural Killer Cells – are responsible for killing if
MHC I cells fail to respond. NK cells are CD16
and CD56, and do not require Thymus for
Maturation. They are activated by IL 12
20. Adenosine Deaminase – deficient in SCID and
Adenosine accumulates and is toxic to T
lymphocytes.
186
geNetICs
 1.Progressive arthritis which Mimic osteoarthritis or
Ankylosing spondylitis + urine darkens progressively when
GENETICS PEARLS
left standing because of high content of homogenistic acid
is = Alkaptonuria
 2.Treatment Of Alkaptonuria is : dietary restriction of
tyrosine and phenylalanine
 3.Normal female gentila + pubic and axillary hair absent +
primary Amenorrhea + 46XY + ovaries absent +
undescended testis + bilateral inguinal hernia +
testosterone normal is = androgen insensitivity syndrome
 4.Patients with Klinefters with XXY who has subfertility and
wants to father children then = Intracytoplasmic sperm
injection is best
187
 5.Pigmented sclera + urine turns black + intervertebral disc
calcification + back pain + renal stones is = Alkaptonuria
 Treatment is :high dose of vitamin C Dietary restriction of
phenylalanine and tyrosine
 6.Upward lens dislocation supratemporal ectopia lentis + blue sclera
,myopia + Aortic incompetence dilation aortic sinus Aortic aneurysm
,aortic dissection MVP + mental normal + high arched plate + tall arm
GENETICS PEARLS
to span ratio 1.05 + pectus excuvtum Dural ecstasy is = Marfan's
Syndrome
 7.Treatment of Marfan's Syndrome is :
 Beta-blockers
 ACEI
 8.Down ward dislocation of lens + no aortic incompetence + mental
retardation + atrial and venous thrombosis + malar flush + livedo
reticularis + seizure fine fair hair osteoporosis is = Homocytinuria
 9.Investigatin of choice in Homocytinuria is = Cyanide nitroprusside
test
 10 Homocytinuria is treated by = vitamin B6 (pyridoxine) Cysthonia
synthase
188
11.Massive hepatosplenomegaly + spleen
rapture + bone weakness osteoporosis +
osteopenia + Aseptic necrosis of femur +
Pancytopenia + bruise easily + yellow brown
GENETICS PEARLS
skin pigment + yellow brown papules
(pingueculae) Erlenmeyer flask shaped cyst +
scelrocorneal junction is = Gaucher's disease
type 1
12.Investigation Of Gaucher's disease are :
enzyme analysis high tarate resistant acid
phosphatase hexosomaonses chill trioside high
Alp + ace + immunoglobins cracked paper
189
13.X-linked recessive conditions - no male-to-
male transmission
14. X-linked recessive conditions - there is no
male-to-male transmission. Affected males can
GENETICS PEARLS
only have unaffected
sons and carrier daughters.
15 Klinefilters - LH & FSH raised
Kallman's - LH & FSH low-normal
16. Red Ragged Muscle - is seen on the biopsy in
Mitochondrial Myopathy. This is a mitochondrial
disease and thus only transmitted through
mother
190
17.Vitamin D resistant rickets is x linked dominant.
18. . X linked disorder are :
Becker/Duchene muscular dystrophy
Alport Syndrome
Fragile X
GENETICS PEARLS
G6PD
Haemophilia A/B.
19.history of alcohol + Bullae develop on sun-exposed areas +Urine: elevated

uroporphyrinogen (Urinary porphyrins)and pink fluorescence of urine under
Wood's lamp + Porphyrins are increased in liver, plasma, urine and stool is = Porphyria
cutanea tarda (PCT)
20. 20-40 year olds + abdominal symptoms, neuropsychiatric symptoms

+ hypertension and tachycardia + peripheral neuropathy + urine turns deep red on
standing + Patients excrete urinary porphobilinogen (PBG) between and during acute
attacks + no photosensivity is = Acute intermittent porphyria (AIP)
191
BIOCHEMISTRY & METABOLISM PEARLS
BIoCHeMIstry & MetaBolIsM
1.Causes of Respiratory Alkalosis :
Central :stroke , meningitis,CNS tumour
Drugs :aspirin Anxiety
Pregnancy
2.Causes of metabolic alkalosis:
Vomiting
Anorexia Nervosa,
Gastric outlet obstruction
Ingestion of base
Prolonged
hypokalaemia
Burns
3. Hydroxylation of Lysine to Proline – occurs in RER and requires Vitamin C
4. Dietary Energy – 9 kCal per gram of Fat, 4 kCal per gram of Carbs and
Protein and 7 kCal per
gram of Ethanol.
192
5.Causes of HIGH anion gap acidosis are :

MUDPILES
Methanol
Uraemia
DKA
Paraldehyde
Infection
Lactic acidosis
Sailyctes.
6.Causes of normal anion gap acidosis are :
HARD ASS
H = Hyperalimention
A:addision disease/Ammonium chloride
RTA
Diarrhoea
Acetazolamide
Spironolactone
Saline infusion
193
 7.Niacin – decreases synthesis of triglycerides and VLDL, by suppressing

the release of fatty acids
from peripheral tissue. Side Effects are flushing, which can be
prevented by administration Of Aspirin
 8. Gluconeogenesis – is a major controller of glucose, during an

overnight fast, where it converts
pyruvate to oxaloacetate and oxaloacetate to phosphoenol pyruvate

 9. Insulin – activated Protein Phosphatase in the cells, and it works
through Tyrosine Kinase
receptor in the cells to stimulate synthesis of fatty acids, protein,
glycogen.
 10.• Patients with Bilateral Cataracts and no Hepatic Involvement –

have a deficiency of Galactokinase and thus Galactose is shifted and
converted into Galactitol by Aldose Reductase
 and thus it accumulates in the lens of the eye without Hepatic
Involvement
194
pHysIology
 1. Glucose Transport – into cells occurs by Facilitated Diffusion
PHYSIOLOGY PEARLS
 2. Aldosterone – increase sodium and water reabsorption in the
collecting ducts.
ADH – increases water reabsorption in the collecting tubule
 3. Cortisol – sensitizes vasoconstricitve effects of

 Catecholamines and thus exerts Permissive Effects on the
Vasculature.
 • Endogenous Administration of Thyroid Hormone – such as

Levothyroxine, will increase the Free
Levels of T3 and thus in its turn suppress TRH and then TSH levels.
195
 4.Thyroid Hormones – alter Gene Transcription by Binding to
Receptors Inside the Nucleus.
 5. Protein M – is a major Virulence Factor of Strep. Pyogens

and Inhibits Phagocytosis and Complement Activation
PHYSIOLOGY PEARLS

 6. Sucrose – is a combination of Glucose and Fructose.
• Lactose – is Galactose and Glucose
• Maltose – is Glucose and Glucose

 7 .IGF-1 of the Liver – is responsible for Growth Hormone
Effect in Human Growth
• IGF -1 from Hypothalamus – is not Responsible for the
Growth, but more for CNS Activity
196
8. Transudates (protein < 30gdl or 75% of the serum albumin) are due to:
-
Reduced intravascular oncotic pressure (hypoalbuminemia)
- Increased intravascular hydrostatic pressure (cirrhosis, portal hypertension, CCF)
9. GUT hormones
PHYSIOLOGY PEARLS
cholecystokinin (duodenum & jejunum) increases gall bladder contraction, increases
colonic motility.
Gastrin (gastric antrum & duodenum) increases gastric acid secretion, increases GI
mucosal growth.
Secretin(duodenum & Jejunum) increases pancreatic bicarbonate production.
VIP(enteric nerves)increased intestinal secretion, splanchnic vasodilation.
Motilin (whole gut) increases small bowel motility.
Bombesin (gut & Pancreas)stimulates pancreatic exocrine activity.
Neuropeptide Y (enteric nerves)regulates intestinal blood flow.
Somatostatin (stomach & pancreas) inhibits secretion and action of gut hormones.
Glucagon(pancreas)reduces GI motility
10. hyporeflexia is a common clinical sign in patients with hypercalcemia.

Bisphosphonates inhibit bone resorption and are the first line pharmacological
treatment of hypercalcemia of malignancy.
197
aNatoMy
 1.Weakness of shoulder abduction + numbness over
ANATOMY PEARLS
regimental badge area + fits + damage to proximal humeral
shaft is = axillary nerve palsy
 2.Pain reduced sensation tingling along anterolateral arm
and lateral part of forearm + reduced power of elbow
flexion + tinnels sign positive is = musculocutaneous nerve
palsy
 3.Fall when stopped by grasping fixed objects in one hand +
loss of intrinsic hand muscle weakness long flexor and
extensor sensory loss medial half of ring and little finger
global wasting of small hand muscle medial border of
forearm and around elbow is = Klumpkes paralysis due to
damage to t1 and C8
198
4. Winging of scapula (C5-C7) + shoulder
abduction weakness (C5) + weakness in elbow
extension (C5) + triceps reflex loss(C7) +
sensory loss lateral shoulder (C5) is = brachial
ANATOMY PEARLS
plexopathy C5-T1
5.Loss of probation of forearm +weakness of
flexor of thumb and index finger is = anterior
interossous nerve
6.Eye deviated down and out + ptosis +
Mydriasis + unreactive pupil to light is = third
nerve palsy
199
 7.Foot drop + dorsiflexion of foot + eversion of foot
+ sensory loss over dorsum of foot , lateral part of
leg spasms 5th toe is = common peroneal nerve
ANATOMY PEARLS
palsy
 8.Weakness in plantar flexion + inversion and
decreased ankle jerk absent is = tibial nerve palsy.
 9.Hip flexion + knee extension + knee reflex +
decreased of anterior thigh medial leg = femoral
nerve plasy L2-L4.
 10.Ankle inversion + hip abduction is = L5
 11.Hip abduction obututor nerve
200
 12.Remember when do of third nerve palsy check 4th also trochleae
which causes in torsion of eye internal rotation of eye effected due to
3rd nerve palsy.
 13.Prepatellar Bursa – commonly seen in roofers, carpenters, people
who are kneeling all the time
ANATOMY PEARLS
 14. Motor Innervation of the Tongue – provided by Hypoglossal Nerve
(12), except for palatoglossus
which is innervated by Vagus Nerve (10)
 15. Sensation of the Tongue – Anterior 2/3 is Mandibular Branch of

Trigeminal Nerve, Posterior 1/3
is by Glossopharyngeal Nerve (9)
 16. 1st Pharyngeal Pouch – external auditory meatus, primary tympanic

cavity and auditory tube
• 2nd Pharyngeal Pouch – Palatine Tonsils
• 3rd Pharyngeal Pouch – Thymus, Inferior Parathyroid Gland
• 4th Pharyngeal Pouch – Superior Parathyroid Gland.
201
 17.Phrenic Nerve – which innervates diaphragm, arises
from C3-C5
 18. VPL – receives input from Spinothalamic and is a

relay for Pain, Temperature, Proprioception.
ANATOMY PEARLS
• VPM – is a relay for Gustatory Pathways
 19. Lateral Geniculate Body – pathway for Vision

• Medial Geniculate Body – pathway for Auditory.
• Olfactory – doesn’t have a relay through the
Thalamus.
 20. Common Peroneal Nerve – is mostly commonly

injured in the trauma near the head of fibula and will
cause Foot Drop.
202
Cell BIology
 1.Molecular biology techniques:-
CELL BIOLOGY PEARLS

SNOW (South - North - West)
DROP (DNA - RNA - Protein)
 2. SER – functions in synthesis of Lipids, Carbohydrate Metabolism and
Detoxification of Harmful substances
 3. cAMP pathway - α2, β1 and β2
 • Inositol Pathway – α1 adrenergic, muscarinic, cholinergic
 4. Ribosomal RNA – is synthesized in Nucleolus. It’s the proteins that are

synthesized in RER
 5. Phospholipase C - forms IP3 and DAG from phospholipids. And IP3 causes
an increase in
intracellular calcium, which then activates Protein Kinase C.
203
 6. Uroporphyrinogen Synthase – is an enzyme deficient in
patients with Porphyria
 7. Retinoblastoma Protein (Rb) – is a regulator of G1 to S

phase transition.
CELL BIOLOGY PEARLS

 • p27 protein – is a cell cycle inhibitor, so malignant cells will
have low number of p27 cells
 8.bcl-2 is an inhibitor of apoptosis.

Fas and caspases promote apoptosis but are not tumour
suppressor genes
 p53 is a tumour suppressor gene that inhibits mitosis and

promotes apoptosis.
ras is oncogene.
204
 9.p53 = Li - Fraumeni syndrome
APC = Colorectal cancer
BRCA1 = Breast and ovarian cancer
BRCA2 = Breast and ovarian cancer
CELL BIOLOGY PEARLS

NF1 = Neurofibromatosis
Rb = Retinoblastoma
WT1 = Wilm's tumour
Multiple tumour suppressor 1 (MTS-1,
p16) = Melanoma
 10. Catabolism of very long chain fatty acids and amino

acids Results in the formation of hydrogen peroxide
occurs at = Peroxisome
205
BIostatICs
 1. 0dds - remember a ratio of the number of people
BIOSTATICS PEARLS
who incur a particular outcome to the number of
people who do
not incur the outcome, NOT a ratio of the number of
people who incur a particular outcome to the total
number
of people
 2. Positive predictive value = TP / (TP + FP)
 3. To calculate the Risk – divide the number of diseased
individuals by the total number of patients
in the group.
206
4. Mode
mode is the most commonly observed value
Mean
The mean is the average value of observations, and therefore very sensitive to extreme values in a
distribution .
Median it is middle number.
the observation that divides the frequency distribution by half and is equal to the 50th
BIOSTATICS PEARLS
centile (lies exactly between each end of a range of values.
5. Sensitivity = true positives / (true positives + false negatives)

Specificity = true negatives / (true negatives + false positives
6. Sensitivity TP / (TP + FN ) Proportion of patients with the condition who have a positive test
result
Specificity TN / (TN + FP) Proportion of patients without the condition who have a negative
test result
Positive predictive
value
TP / (TP + FP) The chance that the patient has the condition if the diagnostic test
is positive
Negative predictive
value
TN / (TN +
207
 7. What is the correct formula to calculate the negative predictive value of a
screening test? TN / (TN + FP)
 8. Incidence is the number of new cases per

population in a given time period.
BIOSTATICS PEARLS
 Prevalence is the total number of cases per
population at a particular point in time
 9. Cohort study Observational and prospective. Two (or more)are selected

according to their exposure to a
particular agent (e.g. medicine, toxin) and followed up to see how many
develop a disease or other outcome.
 The usual outcome measure is the relative risk
 10. Case-control study Observational and retrospective. Patients with a

particular condition (cases) are identified and matched with controls. Data is
then collected on past exposure to a possible causal agent for the condition.
The usual outcome measure is the odds ratio.
208
past papers
1.The history of retching followed by bright red blood in the vomitus and the
normal findings on endoscopy is = Mallory–Weiss tear.
PAST PAPERS PEARLS

2.treatment of Mallory Weiss tear is =
The patient is haemodynamically stable and requires no specific
intervention save reassurance and advice on safe consumption of alcohol.
2.History of codeine use + initial constipation then profuse diarrhoea + faecal
loading on x-ray + normal inflammatory markers and normal WBC is =
Overflow diarrhoea
Treatment : oral stool softener like sodium docusate, switch codeine into
meptazinol
Diverticular disease ,Ulcerative colitis ,Clostridium diffcle has high wbcs,raised
inflammatory Marker
3. Management of coaraction of aorta includes control of
hypertension and assessment for possible balloon angioplasty +/- stenting or
surgical repair of the lesion.
4. Linezolid more than vancomycin in post influenza if fluxoaclin is
contraindicated .
209
 5.Diuretics causes gout so stop it.
 6. In osteomyelitis next step is MRI ,once diagnosis is
confirmed then surgical debridement.
 7. giant A wave seen in pulmonary stenosis and tricuspid
PAST PAPERS PEARLS

stenosis .
 8.Cardaic arrest occurred and CNS impairment outcomes
improved by period therapeutic hypothermia with respect
to CNS status at discharge.
 9.Best next step after chest x-ray for sarcodosis is CT
chest .
 More accurate is trans bronchial biopsy
 10.Majority of cases e coli recover sponteoulsly
 Do not use antibiotics
 11.Post transfusion few days after developed patchie,
purpura, bruises is = post transfusion purpura
 Treatment : high dose iv immunoglobins
210
 12.Low IgG + low igA + respiratory and git infections is =
Common variable immuno defiency
 Treatment: immunoglobins replacement.
 13.Suspion of celiac disease but antiendomysial antibody
and igA negative next step is immunoglobins
PAST PAPERS PEARLS

electrophoresis to exclude isolated igA defienancy u can
do duodenal biopsy and other tests of caelic disease after
this.
 14.Ingestion of amyl nitrate causes methaeglobimia give
methylene blue.
 15.Small poorly reactive pupils + decreased respiratory
rate is = opiate overdose
 Give iv naloxone if consciousness doesn't improve then
give intubation ventilation.
 16.Pseudomonas in cystic fibrosis treated by nebulized
tobramycin and oral azithromycin 6monthly
211
 17.HIV patient + painless lesion on glans penis with
rolled edges inguinal lymphadenopathy is syphilis.
 18.Nice guidelines recommends that all patients who
present to emergency department fallowing episode of
self Harm should be offered psychological assessment
PAST PAPERS PEARLS

 19.Erythema nodsum and u suspected sarcodosis next
step chest chest x-ray not CT thorax.
 20.HIT-2 occurs at 48-72 hour platelets falls below 100
Treatment: stop LMWH and change to donaproid or
Lepirudin
 Hit 1 occur after 5-10 days Rarely platelets falls below
100 Treatment: observation and continue LMWH
 21.Extrapyramidial signs Parkinson + iv drug user is =
Heavy metal Poisoning.
 22.Thyroxine requirements increased by rifampicin not
INH
212
 24.Antipyschotic/slower onset + low reflexes + lead pipe rigidity +
normal pupils + tachycardia + pyrexia diaphoresis high BP +high Ck + is=
neuroleptic malignant syndrome
 Treatment IV fluids Benzodiapines
 Dantrolene
PAST PAPERS PEARLS

 Bromocriptine.
 25.Tramadol co prescribed with SSRI cause serotonin Syndrome.
 26.Agitation + hyponatremia + serotonin Syndrome + hyperpyrexia is =
Cathinone toxicity
 Treatment: Benzodiapines,cooling,hypertonic saline if hyponatremia
 27.He said he is Jesus bec23 Ecstasy/SSRI/amphetamines/monoamine
oxidase inhibitor + Hyperreninemia, myoclonus, rigidity + fever +
altered mental status+ clonus + dilated pupil + faster in onset +
tachycardia high BP + high Ck is = Serotonin Syndrome
 Treatment : Iv fluid Benzodiapines
 Severe cases cryptoheptadine,chlroprmazine.
 28.He said he is Jesus because God spoke to him through TV is = Acute
psychosis which may be related to underlying primary schizophrenia
Treatment: resperidone
213
 29.Nice guidelines for management of painful sickle cell crisis
recommends strong opiate delivered by iv route
 30.Manic episode + risk to herself give = IM Lorazapam
sedation
 If not available then Haloperidol.
PAST PAPERS PEARLS

 31.High PEEP low tidal volume respiratory rate up to 35 is
treatment for ARDS
 32.If there is still Diarrhoea after Cholestrayamine use in ileal
resection Crohn's then add codeine phosphate
 33.In suspected case of gout therapy in Infective cause 1st is
knee Aspiration
 34.In pregnancy and chlamydia give azithromycin not penicillin
 35.False beliefs that she some one trying to harm her she z
afraid that they see her and will hurt her she has proves of it
like they keep garbage outside to trap her
 Other example is feelings insects crawling over skin =delusions
(false believe)
214
 36.She laughs and giggles for apparent reason and she is unable to
dress or shower herself ,rocking muttering softly herself =
Schizophrenia in disorganized type
 37.Unable to eat or drink anything unresponsive both vocally and
nonverbally she resist any attempt to be moved socially isolated
bizarre and speak people no one else could see = Cationic
PAST PAPERS PEARLS

schizophrenia
 38.He has not slept ,bathed ,eaten lack of personal care, in talks to
himself hallucinations is and he says some one stealing his thoughts he
fallow making him unable do school material he is crying feeling of
suicide is = Schizoaffective disorder
 39.Hallucinatory voices commanding him to do things hum or laugh
+delusions like girl friend wants to leave him and he has illness won't
live more than 1 year + hallucinations of smell i.e. he smell of fish +
neglect personal hygiene = Paranoid schizophrenia
 40.Side effects of Exogenous androgen is paranoid delusions and
aggressive behaviour
 41.Sertraline and citalopram appear be safest with antidepressants
with Warfarin
215
 42.Alzheimer's + psychic features like slapping his wife and
inhibitor = give antipsychotics like olanzapine
 43.Bilateral femoral bruits and absent dorsalis pedis pulses +
abnormal lipid profile + pain in both calves + pain starts after
PAST PAPERS PEARLS

walking relieved by rest is = periarterial arterial disease
 Treatment: start statin with target LDL of less than 2
 44.Buttock and thigh claudication +normal straight leg raise +
pain relieved by rest is = lumbar Spinal stenosis
 Investigation is : MRI shows loss of epidural fat on T1 weighted
images loss if csf signal around Dural sac and degernative disc
disease
 Treatment : DE compressive lumbar laminectomy first line
surgical intervention
 45.Normal straight leg raise in spinal stenosis differentiate it
from other causes of lower limb nerve pain
 46.In prolapsed lumbar disc there is pain on straight leg raise
216
 47.Peripheral vascular disease associated with reduction in
ABPI
 48.Long term management in obstructive sleep apnoea is
weight loss
 49.In overuse headache stop paracetamol taper codeine and
PAST PAPERS PEARLS

start naproxen
 50.Ventricular bigemini = Reassurance if she compliant of
further episodes of palpitations then 72 Holter monitor
 51 Talc pleurodesis is best for patient of Mesothelioma with
plural effusion
 52.Pharyngitis + abnormal LFTs = CMV infection
 53.Complicated abscess or those >5 cm in diameter usually
require surgical intervention to achieve adequate drainage
 54.Hypertension + localized cerebellar signs = Cerebellar
haemorrhages.
 55.1st line in human bite is = Co amoxiclav
 2nd line metronidazole doxycycline
217
 56.Best evidence with respect to virus clearance in
hepatitis B is= Entecavir
 57.Licorice = low Aldosterone and low renin
PAST PAPERS PEARLS

 58.HIV patient + mononuclear Leucocytosis +
raised csf + Ventricular enlargement is = CMV
encephalitis
 59.To localize phaeochromocytoma and not to
know that adenoma is realising catecholamine =
MIBG scan
 60.Student house + headache + nausea vomiting +
confusion vertigo + pink skin mucosa + weakness +
arrthymais + coma + red lip + lactic acidosis is =
Carbon monoxide poisoning
 Investigation :pulse oximeter to measure level CO
218
Questions distribution for part -1
219
220
Questions distribution for part-2
• Part -2 has images questions including :

• Ecgs ,chest x- ray ,MRI,CT scan ,bone scan,
pathology slides , ophthalmology pictures
,ECHO, Pulmonary volume loops
• 40 questions approx. are from pictures
questions ,where long scenario with image is
given and investigation diagnosis or treatment
is asked .
221
222
How to attempt exam paper.
1.Read question well with full concentration (if you don't read
question well no matter how good u are ,u won't make it correct )
2.Exclude options which are pretty wrong 1st
3.when You are confused b/w two options click the one which hit 1st in
your mind and move and don't rethink again
4.never Change your 1st marked question until u are 100% sure that u
marked completely incorrect option
5.when u have no idea about question click the one which has longer
statement (mostly they are right)
6.if you have short time like in Mrcp part-2 written try to read options
1st then come to question ,it will give you an idea ,what question will
ask for and it will save your time too.
7.If u are not sure about correct answer and want to spend bit more
on question then just give little dot on answer which u feel may be
right and come back in the end if time remains .
223

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FARAZ’S PEARLS

➡ Chapter wise POINTS for part-i & part-ii

By: Dr Faraz Ahmed

All rights reserved

10.INFECTIOUS DISEASE ……………………………………………108

18.QUESTIONS DISTURBATION PART-I…………………….219

19.QUESTIONS DISTURBATION PART-II……………………221

20 .HOW TO ATTEMPT PAPER …………………………………..223

 Faraz’s pearls for MRCP: Read Faraz's pearls in last 25 days

Sample papers : solve sample paper before 10 days of your

 2.leaving sample paper for last 5 days

 3.reading lengthy books

 4.not reading said theory books

 5.making day off from studies

 6.overuse of face book

 7.not taking participation in whatsapp discussion

47. Thrombocytopenia + micro vascular haemolysis (normocytic anaemia, high LDH,

54.T scores > -1 =Normal

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

INFECTIOUS DISEASE PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

PHARMACOLOGY& TOXICOLOGY PEARLS

 17. Acute Rejection - occurs within weeks of

19.history of alcohol + Bullae develop on sun-exposed areas +Urine: elevated

20. 20-40 year olds + abdominal symptoms, neuropsychiatric symptoms

BIOCHEMISTRY & METABOLISM PEARLS

BIOCHEMISTRY & METABOLISM PEARLS

 8. Gluconeogenesis – is a major controller of glucose, during an

 10.• Patients with Bilateral Cataracts and no Hepatic Involvement –

 3. Cortisol – sensitizes vasoconstricitve effects of

 • Endogenous Administration of Thyroid Hormone – such as

 5. Protein M – is a major Virulence Factor of Strep. Pyogens

10. hyporeflexia is a common clinical sign in patients with hypercalcemia.

 15. Sensation of the Tongue – Anterior 2/3 is Mandibular Branch of

 16. 1st Pharyngeal Pouch – external auditory meatus, primary tympanic

 18. VPL – receives input from Spinothalamic and is a

 19. Lateral Geniculate Body – pathway for Vision

 20. Common Peroneal Nerve – is mostly commonly

CELL BIOLOGY PEARLS

 3. cAMP pathway - α2, β1 and β2

 • Inositol Pathway – α1 adrenergic, muscarinic, cholinergic

 4. Ribosomal RNA – is synthesized in Nucleolus. It’s the proteins that are

 7. Retinoblastoma Protein (Rb) – is a regulator of G1 to S

CELL BIOLOGY PEARLS

 8.bcl-2 is an inhibitor of apoptosis.

 p53 is a tumour suppressor gene that inhibits mitosis and

CELL BIOLOGY PEARLS

 10. Catabolism of very long chain fatty acids and amino

5. Sensitivity = true positives / (true positives + false negatives)